Trends in Racial and Ethnic Diversity in Vascular Neurology Fellowships From 2006 to 2018: A Cross-Sectional Analysis.

BACKGROUND: Workforce diversity in vascular neurology is a crucial component of reducing disparities in stroke care and outcomes. The objective of this study is to describe trends in the racial and ethnic diversity of neurology residents pursuing vascular neurology fellowship and propose an actionable plan for improvement. METHODS: This was a cross-sectional study of race/ethnicity of neurology residents and vascular neurology fellows using published Graduate Medical Education census reports from 2006, when race/ethnicity data were first included, to 2018. Percentage of trainees underrepresented in medicine are reported for 3-year epochs and were analyzed using the Cochran-Armitage test (χ2 test for trend). RESULTS: Across the study period, underrepresented in medicine representation has not changed significantly among all neurology residents and subspecialty fellows (11.9% in 2006-2009; 12.5% in 2015-2018, P=0.82) nor among neurology residents alone (12.0% in 2006-2009; 12.6% in 2015-2018, P=0.81). Among vascular neurology fellows, however, there was a significant downtrend of underrepresented in medicine representation from 16.9% in 2006 to 2009 to 9.3% in 2015 to 2018 (P=0.013). CONCLUSIONS: Racial/ethnic underrepresentation among all neurology residents as well as those pursuing vascular neurology fellowship has persisted across the study period. Concerted efforts should be pursued to increase diversity in neurology residents and vascular neurology fellowship training.

Developing the Neurology Diversity Officer: A Roadmap for Academic Neurology Departments.

Academic Neurology Departments must confront the challenges of developing a diverse workforce, reducing inequity and discrimination within academia, and providing neurologic care for an increasingly diverse society. A neurology diversity officer should have a specific role and associated title within a neurology department as well as a mandate to focus their efforts on issues of equity, diversity and inclusion that affect staff, trainees and faculty. This role is expansive and works across departmental missions but it has many challenges related to structural intolerance and cultural gaps. In this review, we describe the many challenges that diversity officers face and how they might confront them. We delineate the role and duties of the neurology diversity officer and provide a guide to departmental leaders on how to assess qualifications and evaluate progress. Finally, we describe the elements necessary for success. A neurology diversity officer should have the financial, administrative and emotional support of leadership in order for them to carry out their mission and to truly have a positive influence.

The relationship between mood disorder and insomnia depends on race in US veterans with epilepsy.

PURPOSE: Few data exist on race, medical/psychiatric comorbidities, and insomnia symptoms in US veterans with epilepsy. Our aims were to examine 1) whether insomnia symptom prevalence was different between Black and White veterans and 2) whether predictors of insomnia symptoms varied by race. METHODS: This retrospective, cross-sectional study included veterans evaluated in an epilepsy clinic over the course of 1.5years. Individuals completed standardized assessments for epilepsy and sleep complaints. Insomnia criteria were met by 1) report of difficulty with sleep initiation, maintenance, or premature awakenings accompanied by daytime impairment or 2) sedative-hypnotic use on most days of the month. Demographics, medical/psychiatric comorbidities, and medications were determined per electronic medical record review. Hierarchical multivariable logistic regression analyses were performed to determine if race, medical/mental health comorbidities, and the potential interaction of race with each comorbid condition were associated with insomnia. RESULTS: Our sample consisted of 165 veterans (32% Black). The unadjusted prevalence of insomnia was not different between Black and White veterans (42% vs 39%, p=0.68). In adjusted analyses, the association between mood disorder and insomnia varied by race. Depressed White veterans had over 11-times higher predicted odds of insomnia (OR 11.4, p<0.001) than non-depressed White veterans, while depressed Black veterans had 4-times higher predicted odds of insomnia (OR 4.1, p=0.06) than non-depressed Black veterans. Although mood disorder diagnosis was associated with insomnia for both racial groups, White veterans had a stronger association between mood disorder diagnosis and insomnia than Black veterans. CONCLUSIONS: The relationship between mood disorder diagnosis and insomnia was stronger for White than Black veterans with epilepsy. Future studies are needed to explore mental health symptoms and psychosocial determinants of insomnia with larger samples of minority individuals with epilepsy.