The percentage of women and underrepresented racial and ethnic groups (UREGs) in the Duke Cardiovascular Disease Fellowship Program increased from 2017 to 2019 following implementation of interventions to promote equity of opportunity, according to a study published in JAMA Network Open.

As part of an initiative which was launched in 2017, a fellowship diversity and inclusivity task force was created and tasked with drafting recommendations and reorganizing the fellowship recruitment committee. Changes were made to the applicant screening process, the interview day, applicant ranking process, and post-match interventions.

In the decade prior to the implementation of this initiative, the fellowship received a mean of 462±55 applications per year. From 2017 to 2019, the program received a mean of 611±27 applications annually.

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 The annual mean percentage of women applicants and applicants from UREGs increased during the 2017 to 2019 period compared with the 2006 to 2016 period (women: 26.4% vs 22.4%, respectively; P <.001; UREGs: 12.5% vs 10.5%, respectively; P =.01).

The percentage of women and people from UREGs who were interviewed for the fellowship increased between the 2006 to 2016 period (20.0% and 14.0%, respectively) and the 2017 to 2019 period (33.5% and 20.0%, respectively; P =.01 for both).

Prior to implementation of the equity of opportunity improvement initiative, a mean of 23.2% women and 9.7% people from UREGs matriculated as first-year fellows, compared with a mean of 54.2% women and 33.3% people from UREGs after the intervention.

The percentage of women in the overall fellowship increased from a mean of 27.0±8.8% over 5 years to a mean of 54.2±7.2% after the 3-year intervention period, and the percentage of people from UREGs increased from 5.6±4.6% to 33.3±19.0% during this time. The percentage of applicants in the overall population who were women or from UREGs rose from 27.8% to 66.7%.

A limitation of this study was the inability to determine whether the interventions were directly related to the increase in fellowship applications or if other factors were at play.

 “Our experience can serve as a model to other programs seeking to increase diversity of their trainees,” concluded the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Rymer JA, Frazier-Mills CG, Jackson LR 2nd, et al. Evaluation of women and underrepresented racial and ethnic group representation in a general cardiology fellowship after a systematic recruitment initiative. JAMA Netw Open. Published online January 4, 2021. doi:10.1001/jamanetworkopen.2020.30832