To the Editor:In their report on the demographic data of United States residents in training across multiple specialties, Atkuru et al1Atkuru A. Lieng M.K. Emami-Naeini P. Trends in racial diversity among United States ophthalmology residents. reveal that ophthalmology had the lowest proportion of residents who were underrepresented in medicine (URM) in the 2019–2020 academic year. We agree with the authors’ assessment that insufficient exposure to ophthalmology during medical training may be a major contributor to the lack of diversity in the field. As specialties compete for limited teaching time within medical school curricula, it seems that ophthalmology is falling behind in the race. For many students, clinical exposure to ophthalmology will only come from elective rotations. Among medical schools affiliated with the Association of University Professors of Ophthalmology in 2018, Moxon et al2Moxon N.R. Goyal A. Giaconi J.A. et al.The state of ophthalmology medical student education in the United States: an update. reported that required clinical ophthalmology rotations only existed at 16% of responding institutions. This is a sharp decrease from in 2000, when the same proportion of institutions with mandatory ophthalmology rotations was reported to be as high as 68%.3Quillen D.A. Harper R.A. Haik B.G. Medical student education in ophthalmology: crisis and opportunity. Currently, for medical students who do not choose to partake in an elective ophthalmology rotation, there may never be any clinical exposure to the specialty before residency applications. The numbers point to the need of both a high-risk approach directed toward URM medical students, as well as a population approach to generate a greater overall interest in ophthalmology.Ophthalmology interest groups (OIGs) encourage students to explore aspects of the specialty that may otherwise be overlooked. OIGs provide earlier exposure to the field by regularly hosting school and community events, establishing physician mentorships, and broadcasting relevant news and opportunities in ophthalmology to students. Because these organizations are primarily student run, they also have the unique capability of being able to target URM students directly. In our experience as members of the board of the OIG at our own medical school, we have found that connecting students with alumni specializing in ophthalmology to be the most effective way of increasing student interest and engagement. Despite lacking a home ophthalmology department, alumni are often eager to return and offer their time in the form of panel discussions, surgery/procedure viewings, and ophthalmic clinical skills laboratories. In cases where opportunities such as these are not normally provided within the curriculum of medical schools, OIGs have the capacity to step in and fill that gap. Moxon et al2Moxon N.R. Goyal A. Giaconi J.A. et al.The state of ophthalmology medical student education in the United States: an update. report that 89% of responding medical schools in their 2018 survey had active OIGs. Furthermore, increasing the prevalence of OIGs, while also encouraging existing OIGs in medical schools to intervene within their institutions, has the potential to improve interest in the field on a national level. This point is especially true for URM students who by nature tend to already be less connected and receive less exposure to the speciality than their peers.Standardizing OIGs to decrease the variability in opportunities across institutions may generate even more favorable results. One way this can be done is by establishing medical school chapters under a national ophthalmology organization. Within neurosurgery, the American Association of Neurological Surgeons (AANS) has allowed medical schools to establish their own student chapters since 2014. These chapters were found to be effective in increasing student interest in neurological surgery. The level of student engagement in an AANS chapter is positively corelated with specialty-specific publications, attendance of annual AANS meetings, and residency match rates.4Agarwal P. Khalafallah A.M. Hersh E.H. Ivan M.E. Mukherjee D. Impact of American Association of Neurological Surgeons Medical Student Interest Groups on participation in organized neurosurgery, research productivity, and residency match success. Replicating a similar system within ophthalmology, in conjunction with increasing efforts made by independent OIGs, may increase the proportion of URM medical students who take interest in the field. Given proper structure and support, medical school OIGs have the potential to play a more active role in recruiting URM students and consequently, improving the current lack of diversity that exists among US ophthalmology residency programs.ReferencesAtkuru A. Lieng M.K. Emami-Naeini P.

Trends in racial diversity among United States ophthalmology residents.

Ophthalmology. ()Moxon N.R. Goyal A. Giaconi J.A. et al.

The state of ophthalmology medical student education in the United States: an update.

Ophthalmology. 127: 1451-1453Quillen D.A. Harper R.A. Haik B.G.

Medical student education in ophthalmology: crisis and opportunity.

Ophthalmology. 112: 1867-1868Agarwal P. Khalafallah A.M. Hersh E.H. Ivan M.E. Mukherjee D.

Impact of American Association of Neurological Surgeons Medical Student Interest Groups on participation in organized neurosurgery, research productivity, and residency match success.

World Neurosurg. 138: e437-e444Article InfoPublication History

Published online: July 04, 2022

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Disclosure(s):All authors have completed and submitted the ICMJE disclosures form.

The authors have no proprietary or commercial interest in any materials discussed in this article.

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DOI: https://doi.org/10.1016/j.ophtha.2022.05.017

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© 2022 by the American Academy of Ophthalmology

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Underrepresented minority (URM) groups in medicine are defined as racial and ethnic populations in the medical field that are underrepresented relative to their numbers in the general population.1 A diverse physician workforce that reflects patient population leads to decreased health care disparities, enhanced access to care, and improved patient outcomes and satisfaction.2 However, the field of ophthalmology has not reflected the racial diversity of the country and URM groups comprise only 7.2% of practicing ophthalmologists in the United States.

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We thank Madu et al for their interest in our study of demographic distribution of ophthalmology residents in training in the United States.1 As the authors pointed out, insufficient meaningful exposure to ophthalmology and decreasing curricular time during medical training has contributed to dwindling interest of medical students in the specialty and disparities in the field. Additionally, the lack of a structured ophthalmology curriculum during medical training can compromise the competency of medical graduates, regardless of their future specialty.

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