Representation Matters: Perceived Barriers to Medical Students Pursuing Ophthalmology

Introduction: Improving our understanding of the barriers that medical students perceive to pursuing ophthalmology may reveal means of increasing accessibility to the field, especially for students underrepresented in medicine (URiM). Methods: A 25-item questionnaire was electronically distributed to United States allopathic and osteopathic medical students from April to May 2022. Subgroup analyses were conducted on respondents who selected ophthalmology as their specialty of choice, respondents who reported that they were no longer pursuing ophthalmology due to barriers, and respondents who identified as URiM. Results: Students at 37 medical schools completed 429 questionnaires. Ophthalmology was the specialty of choice for 51 respondents (11.9%), while 26 respondents previously interested in ophthalmology reported a career change due to perceived barriers (“dropout” group). Of the students pursuing ophthalmology, 14 identified as URiM (27.5%). Ophthalmology-bound and dropout respondents favored the same four barriers to pursuing ophthalmology (overall competitiveness, necessity of research, USMLE scores, and lack of mentorship), but the dropout group was significantly more likely to cite lack of exposure to the field (50% vs 19.6%, p=0.0062) and lack of a home program (53.8% vs 29.4%, p=0.0379) compared to those still pursuing ophthalmology. Significantly more URiM students selected “lack of representation in the field of people of my race or ethnicity” as a barrier to pursuing ophthalmology compared to their non-URiM peers (64.3% vs 8.1%, p Discussion: Medical students perceive multiple barriers to pursuing ophthalmology. Lack of representation is an important barrier to URiM students, on par with quantitative metrics such as research and exam scores. Increasing mentorship and exposure to the field, especially for URiM students and those without a home residency program, may support students in pursuing the specialty. Additional strategies should be investigated to support these students and expand diversity in eye care.