Funded Radiation Oncology Visiting Medical Student Electives: A Cross-Sectional Analysis

Background Visiting electives increase exposure of radiation oncology (RO) programs to medical students, and may influence where students ultimately match. Institutions have increasingly offered scholarships for visiting students in RO to offset the financial burden of visiting electives, often with a focus on increasing access to students who identify as being underrepresented in medicine (URiM). To our knowledge, the availability and distribution of funded electives has not been examined. Here, we characterized the current landscape of funded RO electives. Methods Residency programs offering visiting electives were identified through the FREIDA database. Departments hosting electives without a residency program were identified through the Visiting Student Learning Opportunities (VSLO) database. Funded elective availability and departmental characteristics were identified via internet search by two independent reviewers per elective. Discrepancies were identified and resolved by investigators DB, CM, AG. Fisher's Exact Test was used to determine whether there was a difference in the distribution of scholarships across the US due to the small sample size.  Results 92 visiting electives were identified, with 40 programs offering scholarships (43.5%, 38/40 URiM-specific). 12 (30%) were hosted and funded by the RO department and 28 (70%) were part of institutional URiM scholarships. The median stipend provided was $2,000 (IQR $500), range $1,000-$5,000. 92.6% (25/27) of the programs offered >$1,500. 5 programs (12.5%) did not disclose stipend amount. Geospatial distribution of scholarships by US census tract showed an unequal distribution (Fisher's Exact Test, p = 0.011), with the highest proportions of scholarships observed in New England (75%, 3/4), Mountain (75%, 3/4), and East North Central (68.8%, 11/16) divisions and the lowest proportions in East South Central (0%, 0/5), West South Central (11.1%, 1/9), and Middle Atlantic (32%, 6/19) divisions. Discussion The equity gap presented by visiting electives is large in RO. As of 2015, applicants performed 2.4 visiting electives on average, spending ∼$2,500 total (Winterton et al. BMC Med Educ 2016). Despite the importance of funding to mitigate financial barriers, less than half (43.5%) of RO electives offer support. Most scholarships offer support >$1,500, which mirrors what applicants spent per elective in 2015 adjusted for inflation. We identified an unequal geographic distribution of scholarships, particularly in the South Central and Middle Atlantic divisions, highlighting the need for interventions to address disparities in access. Our study represents a valuable resource for students and highlights the continued need to positively contribute to increasing diversity in the field.