Investigation of change and stability in medical students’ ophthalmology specialty intention from matriculation to graduation: Gender and racial/ethnic differences

Purpose Using data from a national sample of graduating medical students, this study describes the patterns of change and stability in ophthalmology intentions relative to various other specialties and explains how those patterns vary by the intersection of gender and race/ethnicity. Method National survey data from MD-granting medical school graduates who matriculated between 2013-2014 and 2018-2019 and graduated by 2021-2022 were examined. The outcome consisted of four groups based on ophthalmology specialty intention at matriculation and graduation: non-ophthalmology, switched out, switched to, and reaffirmation. Percentages for “reaffirmation” and “switched to” were each compared to the median values for 13 major specialties (including ophthalmology). The outcome was examined by the intersection between gender (men vs. women) and race/ethnicity (White-alone, Asian-alone, underrepresented in medicine [URiM, including Black/African American, Hispanic, Alaska Native or American Indian, or Native Hawaiian or other Pacific Islander alone or in combination with any other race/ethnic group], and all other). Chi-square tests of independence and tests for the equality of proportions were employed. Results Of 59,908 respondents, 1,057 (1.8%) were ophthalmology-intending matriculants (OIMs), and 1,297 (2.2%) were ophthalmology-intending graduates (OIGs). The percentage of OIMs who reaffirmed their intention (33.7% [357/1,057]) was below (P < 0.05) that of the median specialty (37.3%). The percentage of OIGs who switched to ophthalmology at graduation (72.5% [940/1,297]) did not differ from that of the median specialty (72.0%). Among OIGs, URiM men (2.1% [83/4,018]), URiM women (1.3% [69/5,467]), and White women (1.2% [207/17,498]) were underrepresented relative to White men (2.7% [457/16,956]) (each, P < 0.05). Among OIMs, URiM women and White women each had lower percentages (1.4% [76/5,467] and 1.0% [180/17,498], respectively) relative to White men (1.9% [320/16,956]) (each, P < 0.05). URiM women and White women also had lower percentages (26.3% [20/76] and 30.0% [54/180], respectively) of OIMs reaffirming at graduation relative to White men [43.1%; 138/320]) (each, P < 0.05). Conclusion Findings provide further evidence that early recruitment and enrichment opportunities and ongoing retention are essential strategies for ensuring that the field is an attractive career option for a broadly diverse population of medical students. This study provides a template for investigating students’ career intentions during undergraduate medical education.