The importance of diversity in clinical research

Clinical research is a fundamental part of the healthcare system and is critical to improving care, making it safe and effective. Research participants should be diverse as this reduces bias and helps to better understand illness and treatment and how it affects different groups of people. However, due to health inequalities and barriers to research participation, clinical research still lacks diversity. Data from the US Food and Drug Administration showed that 76% of research participants were White and the remaining 24% were from an ethnic minority. In the UK, only 5% of ethnic minorities have ever participated in clinical trials. Recently, with the COVID-19 vaccine trials, out of 270 000 participants, only 11 000 and 1200 participants were from Asian and Black backgrounds, respectively. The research participation of under-represented groups requires co-development with community members. This proactive approach helps establish trust and enhance recruitment strategies that build a positive legacy for under-represented groups.

Focal Laser Photocoagulation for Central Serous Chorioretinopathy in Under-Represented Populations: A Retrospective Case Series

This case series examines visual and anatomic outcomes of focal laser photocoagulation in the treatment of central serous chorioretinopathy (CSCR) with subretinal fluid (SRF) in under-represented populations. We reviewed records of 25 eyes with CSCR and SRF that underwent focal laser photocoagulation. Visual acuity (VA) and central macular thickness (CMT) were recorded prior to laser, after laser treatment, and at final follow-up and were all compared using Wilcox signed-rank tests after using Shapiro-Wilk tests to determine normality. The racial and ethnic breakdown of our cohort (n = 25) includes 64% Hispanic (n = 16), 20% black (n = 5), 12% Asian (n = 3), 4% other (n = 1). Patients were followed for a median of 15.5 months (range: 5.75-87 months) after treatment. The VA prior to laser compared to best-available VA significantly improved (p = 0.0003). Pre-laser CMT to post-laser CMT (p < 0.0001) and pre-laser CMT to final CMT (p < 0.0001) significantly improved. Excluding the one eye that developed a choroidal neovascular membrane, the pre-laser VA to final VA improved significantly (p = 0.0047) as well as the pre-laser CMT to final CMT (p < 0.0001). Of the 25 eyes, 4 had persistent SRF following laser, and of the 21 eyes with complete resolution of SRF, 2 developed recurrent SRF. Focal laser photocoagulation can significantly improve VA and CMT in CSCR with active SRF in patients who have been under-represented in prior clinical studies.

End of the road? The career intentions of under-represented STEM students in higher education

BACKGROUND

The analogy of the leaky pipeline has been used to describe STEM education, with lower student diversity from compulsory to post-compulsory education and beyond. Although extensive research has explored the views and experiences of school-aged children about STEM, fewer studies have examined the career intentions of STEM students at university, especially those from under-represented backgrounds (e.g., racial/ethnic minority, women and working class students). This paper draws on a large qualitative study that interviewed 110 under-represented STEM undergraduates in the UK. We focus on students' STEM career intentions and the likely directions of their post-degree trajectories, drawing on the lenses of science identity and Social Cognitive Career Theory.

RESULTS

Three pathways were identified. The first group plans to pursue a career in or from STEM. While social inequalities may persist, the potential impact of these challenges may be neutralised by the personal drive and passion of STEM career-oriented students, who seem committed to drive into an STEM future. The second group stated intentions for non-STEM-related careers, leaving the STEM pipeline. The reasons students gave for their imminent departure from STEM are the better financial reward on offer in some non-STEM sectors, especially in finance and business, as well as wider social inequalities and stereotypes. The third group was undecided, those who are uncertain or unclear about their futures. Students described a general lack of direction or clear career pathway, from a complete lack of career ideas to an overload of options.

CONCLUSIONS

We conclude with a reminder that the STEM pipeline is far from secured or equitable, despite apparent progress in participation and representation. We reiterate the importance of fostering a diverse, inclusive and supportive learning environment that maximises the participation, strengths and potential of all students, especially those from under-represented backgrounds. While it is not uncommon for STEM students to pursue careers outside of STEM, we need to be wary that those who exit the STEM pipeline are not forced off the road by social inequalities and exclusions.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s40594-022-00366-8.