B38-18 You Can’t Be What You Don’t See: A Qualitative Study on Specialty Choice Among Trainees

Abstract Introduction In Pulmonary and Critical Care Medicine (PCCM), representation of physicians from diverse backgrounds lags behind the already limited diversity seen amongst medical trainees at all levels. While efforts to increase recruitment of underrepresented in Medicine (UIM) trainees to PCCM have gained momentum, the factors that influence specialty choice particularly among UIM trainees remain poorly understood. Methods We conducted two focus groups to explore factors influencing specialty choice and perceptions of PCCM amongst medical students (N = 14, MS1-M3) and residents (n = 7, PGY1-PGY4 Internal Medicine (IM) or IM/pediatrics) Participants reflected a range of racial, ethnic and gender identities with intentional recruitment of individuals identifying as UIM. Study investigators facilitated discussions using an IRB approved questions developed for this project. Sessions were audio recorded, transcribed and analyzed using thematic and content analysis to identify key themes. Results Residents noted that they chose IM for the breadth of clinical experiences, including procedural opportunities, and the diversity of patient populations served. Residents, especially those identifying as UIM, considered the diversity of a program when choosing IM and subspecialty programs, including using filters in application programs to view metrics such as percentage of female and Black faculty and trainees. Medical students noted the importance of identifying peers among residents and understanding the underlying culture of a specialty. Mentorship was described as evolving across training stages. Medical students sought broad life and career-oriented guidance from mentors, while residents sought mentors who could support subspecialty decision making and career navigation. Students noted the importance of having mentors who shared similar backgrounds or lived experiences. UIM students described the impact of seeing faculty who reflected their identities, such as the experience of having their first Black lecturer or a trans faculty member, as pivotal moments of connection and validation. Several barriers to finding mentors were identified by medical students including fear of initiating contact with faculty, lack of flexibility in mentoring relationships and unclear expectations around mentor-mentee roles. Conclusions Residents and medical students from diverse backgrounds described distinct influences on specialty choice. Medical students identified barriers in initiating and navigating mentoring relationships. Participants noted the importance of finding their niche and understanding the underlying culture of a specialty, and highlighted the value of mentors with shared backgrounds or lived experiences. These findings illustrate that specialty choice is shaped not only by clinical interest and mentorship access but by other needs including identity affirmation, cultural fit and psychological safety. This abstract is funded by: ATS Medical Education Grant