Barriers to Pursuing Dermatology in Canada: A Critical Qualitative Analysis of Medical Students from Underrepresented Backgrounds

Abstract

Background:

Dermatology is 1 of the least diverse medical specialties in North America. Despite this, the barriers that Underrepresented in Medicine (URiM) students face in pursuing dermatology are poorly understood. This study aims to explore the challenges URiMs encounter in pursuing dermatology in Canada, with the goal of informing initiatives to enhance diversity and inclusivity within the field.

Methods:

Using critical qualitative inquiry and purposive sampling to ensure gender, race/ethnicity, geographical, and trainee year heterogeneity, we recruited self-identifying URiMs across Canadian medical schools. Online in-depth semi-structured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process, and key themes and subthemes were identified.

Results:

Twenty-four URiMs were included in this study. The interviews revealed 3 major themes that characterized their experiences: journey to medicine and dermatology, sense of belonging in the field, and access to dermatology. URiMs identified limited mentorship, insufficient exposure to the field, financial constraints, undervaluation of advocacy efforts, feelings of isolation, and microaggressions as key barriers to pursuing dermatology. They recommended strategies to address these challenges, including mentorship programs, more holistic residency program selection approaches, and leveraging social media to increase exposure and highlight diversity in dermatology programs.

Conclusions:

This study highlights key barriers URiMs face in pursuing dermatology and provides a foundation for future research and policy changes to increase diversity in the specialty. We strongly encourage dermatology residency programs to implement these recommendations, as doing so will foster greater inclusivity and ultimately improve care for diverse patient populations.

Introduction

Dermatology is 1 of the least diverse medical specialties in North America.^1-3 Despite growing enrollment of Underrepresented in medicine (URiM) students in medical schools, their representation in dermatology remains low.^1-3 In Canada, the Association of Faculties of Medicine of Canada lacks a formal definition of URiM; the Association of American Medical Colleges defines URiM individuals as those self-identifying as American Indian or Alaska Native, Black or African American, Hispanic or Latino, or Native Hawaiian or Other Pacific Islander. ⁴

As of 2025, the Canadian Dermatology Association reported slightly more than 800 certified dermatologists nationwide. ⁵ Although race and ethnicity data for dermatologists are not systematically collected, anecdotal estimates suggest approximately 6 Black and 1 Indigenous practicing dermatologists in Canada, representing roughly 0.75% and 0.1% of the workforce, respectively. ⁶ In comparison, data from the 2021 Canadian census indicate that 4.3% of Canadians identify as Black and 5.0% as Indigenous.^7,8 Owing to the paucity of data, comparisons across specialties are limited. Among the few available reports, approximately 6% of the academic surgical workforce identified as female and as Black, Indigenous, or person of color. ⁹

Diversity in the medical workforce enhances healthcare delivery, yet barriers limiting URiM participation in dermatology remain poorly characterized.^10-13 Physicians from underrepresented backgrounds are more likely to serve underserved communities, and patient-physician racial concordance improves satisfaction and health outcomes.^14-16

This study uses qualitative inquiry to explore barriers URiM students face in pursuing dermatology in Canada and to inform initiatives that advance diversity and inclusion in the field.

Methods

Study Design

We conducted an inductive thematic analysis of 24 in-depth interviews with self-identifying URiM medical students interested in pursuing dermatology. We developed a semi-structured interview guide (Supplemental Text 1) through literature review and pretesting with medical students on the team before study initiation. Interview questions addressed the following domains: (1) motivations for pursuing medicine and dermatology, (2) sense of belonging in the field, (3) barriers to access, and (4) suggestions for improving representation.

Participants were individually interviewed via video conference between April and May 2025 by medical student team members trained in qualitative interview methods (D.S., E.A., E.G., E.O., A.O., J.V.H.T., V.L., and L.S.). Interviews lasted 45 to 60 minutes and were audio recorded, transcribed verbatim, and deidentified. Self-reported demographic characteristics, including race, gender, specialty of interest, and socioeconomic status (SES) during childhood and at present, were collected.

The study was approved by the University of Toronto Research and Ethics Board. Informed consent was obtained from participants using a consent form developed with the University of Toronto Research and Ethics Board. The study followed the Consolidated Criteria for Reporting Qualitative Research guidelines. ¹⁷

Participant Recruitment and Data Collection

Participants were recruited in April 2025 through Canadian medical school listservs, social media groups, and participant referrals. Purposive and snowball sampling were used to achieve diversity in race/ethnicity, gender, and geography. Eligible participants were medical students at any stage of training who self-identified as URiM and had not applied to a dermatology residency program. The final sample size was determined by thematic saturation. Participants received a $20 gift card as a token of appreciation. SES was self-reported using the following definitions provided to participants: Low = difficulty meeting basic needs (eg, food and housing); Middle = able to meet basic needs with some discretionary income; High = comfortable meeting basic needs with significant discretionary income or wealth accumulation.

Data Analysis

All interview transcripts were imported into NVivo (version 14, QSR International) for inductive reflexive thematic analysis. Eight researchers independently reviewed the transcripts with guidance from a qualitative methodologist. Themes and subthemes were identified through iterative team discussions; transcripts were coded by the respective interviewers, and analysis proceeded concurrently with data collection. Data saturation of the themes was achieved as demonstrated by the increasing overlap of issues raised by participants.

The team comprised 8 medical students (D.S., E.A., E.G., E.O., A.O., J.V.H.T., V.L., and L.S.), a dermatology resident (E.A.A), and 2 supervising academic dermatologists (Y.M. and M.J.) from diverse underrepresented backgrounds. Ongoing reflexive discussions minimized bias and ensured validity, enhancing the comprehensiveness of the study.

Results

Twenty-four URiM medical students from 11 Canadian medical schools participated. Fifteen (62.5%) were from Central Canada, 2 (8.3%) from the Atlantic region, 4 (16.7%) from the Prairies, and 3 (12.5%) from the West Coast. Nineteen (79.2%) identified as women and 5 (20.8%) as men. Twelve (50%) identified as Black, 5 (20.8%) as Indigenous or Métis, 3 (12.5%) as South Asian, 2 (8.3%) as Hispanic/Latino, and 1each (4.2%) as East Asian and Southeast Asian. Nearly one-third (33.3%) reported a low socioeconomic background. Most participants were born outside of Canada (Supplemental Table S1).

We identified 3 key themes shaping participants’ experiences: (1) their journey to medical school and dermatology, (2) their sense of belonging in the field, and (3) barriers to access (Supplemental Table S2).

Theme 1: Journey to Medical School and Dermatology

Intersectionality, the interaction of multiple identities, significantly influenced the lives of our participants, who navigated varying levels of sociocultural power and privilege. ¹⁸ Based on this, we identified 3 subthemes in their journey to medicine and dermatology: (1) motivation, (2) community advocacy, and (3) SES.

Motivation

Participants described diverse and often unstructured paths to medicine, shaped by family influence, volunteering, and personal healthcare experiences. Many were drawn to dermatology’s blend of medicine, procedures, and visual diagnostics. A strong motivator was the need for culturally competent care and greater representation. Personal experiences with misdiagnoses on darker skin tones also inspired interest in the field. Many faced unstructured journeys, characterized by uncertainty and a lack of mentorship and guidance. Most participants cited interest in dermatology’s visual and procedural nature and the need for culturally competent care as a primary motivator. Personal experiences, such as difficulties diagnosing conditions on deeper skin tones or challenges accessing quality dermatological care, also inspired many to pursue the field.

However, several URiMs felt conflicted between serving their communities and pursuing dermatology. Some felt pressure to enter primary care or obstetrics, perceiving these fields as more directly impactful. Others faced skepticism about dermatology’s legitimacy, with mentors suggesting they “be real physicians” by pursuing pediatrics or family medicine.

Community Advocacy

Dermatology’s research-heavy culture contrasted with many URiMs’ commitment to advocacy.^19,20 Participants described devoting significant time to equity work, often through Black or Indigenous medical student associations, while peers focused on research. One participant reflected on the pressure to publish: “You hear a lot of stereotypes, and you think you need to have 30 publications.” As a result, many URiM candidates hesitate to apply, fearing that their advocacy-focused extracurriculars may be undervalued by residency programs compared to research publications.

Socioeconomic Status

Financial barriers shaped access and opportunity. Lower-SES students worked part-time to afford application fees, limited the number of schools they applied to, and struggled to engage in research and away electives. Family obligations further constrained time for CV-building activities, reducing perceived competitiveness for dermatology. One participant shared, “Finances are tight. I have to support my family and be there for them outside of studying. I don’t really have time or resources for research or other activities,” highlighting how financial constraints and family obligations limited their ability to strengthen their applications.

Theme 2: Sense of Belonging

When exploring their sense of belonging in dermatology, most URiMs reported challenges, including (1) impostor syndrome, (2) feelings of isolation, and (3) microaggressions.

Impostor Syndrome

Participants frequently felt “less deserving or “less capable” of pursuing dermatology, exacerbated by limited mentorship and stereotypes that dermatology applicants are “gunners.” One participant reflected, “Entering through the Black pathway already comes with doubts about your abilities. When you then pursue a competitive specialty like dermatology, those doubts only increase.” These experiences reinforced feelings of inadequacy, despite meeting identical academic standards as peers.

Isolation

The scarcity of mentors and role models who share their identities left many URiMs feeling isolated. Some noted the lack of diversity in residency programs and online representation, prompting questions like, “If there are no residents that look like me. . . is this even something I should be considering?” These sentiments reflect a broader sense of alienation, as the lack of diversity makes it challenging for URiMs to envision themselves thriving in this specialty.

Microaggressions

Many URiMs shared experiences of microaggressions throughout medical school, where subtle, often unintentional comments and actions reinforced negative assumptions about their intelligence, role, and belonging in medical spaces. ²¹

One participant described overpreparing for electives due to implicit bias:

I studied so much before my dermatology electives. I made sure to dress well, put on makeup, and always present myself as my best self. But as a Black person, I feel like you’re often put at a disadvantage because of implicit biases. I almost felt like, within my limited time, I had to figure out how to be extra competitive, not just because they have to assess my qualifications, but also because I’m Black.

Theme 3: Barriers to Access

We identified 2 main subthemes limiting access to dermatology for URiMs: (1) network limitations and (2) limited exposure to the field.

Network Limitations

Most participants lacked established professional networks, often being the first in their families to pursue medicine. They perceived that those students who successfully matched into dermatology benefited from early mentorship connections that opened doors to research and guidance.

Without such networks, URiMs described dermatology as a “black box,” where information and mentorship were difficult to access. “I worry that I’m not even going to be considered because I don’t have those connections,” said 1 student.

Most participants emphasized that a mentor’s qualities, such as a willingness to understand the unique barriers they face, being honest, and advocating for them, were more important than race-concordant mentorship.

Limited Exposure

Many participants reported minimal early exposure to dermatology. Observerships were difficult to obtain due to limited availability, restricting opportunities to explore the specialty. This late and limited exposure often left students uncertain about pursuing dermatology. Those who discovered their interest later felt particularly disadvantaged: “When I decided to pursue dermatology in the middle of third year, I was really scared. There were people who had been aiming for dermatology from day one.”

Participant-Driven Recommendations

Participants suggested strategies to reduce barriers for URiMs pursuing dermatology, emphasizing mentorship, increased exposure, and transparency in residency selection (Supplemental Table S3).

Many highlighted the value of mentorship programs connecting students with resident and faculty mentors, especially those with shared backgrounds. “Seeing Black residents who got accepted into dermatology programs and being able to reach out to them was very reassuring to me,” one student shared as they referenced a newly created mentorship program. Longitudinal mentorship was considered crucial.

Increasing early exposure to dermatology was another key recommendation. Students suggested seminars, case-based learning, and targeted initiatives to broaden understanding of the field. Participants also emphasized the need to showcase diverse faculty and residents, improve transparency in the residency selection process, and demonstrate a commitment to diversity (Supplemental Table S3).

Discussion

This study explored the barriers URiMs face in pursuing dermatology in Canada, aiming to inform initiatives that promote diversity and inclusivity in the field. Our findings highlight varied motivations for pursuing dermatology, with many URiMs driven by a desire to provide more culturally competent care. However, the pressure to give back to their communities often causes them to reconsider this path. URiMs also feel that their advocacy efforts are undervalued in the residency selection process compared to research publications. Financial constraints can limit their involvement in research and electives. In addition, impostor syndrome, isolation, and microaggressions can diminish their sense of belonging in the field. The lack of professional networks and insufficient early exposure to dermatology leave many URiMs feeling disconnected and uncertain about how to navigate the specialty.

We recognize that some barriers identified, such as financial constraints, limited mentorship, and lack of exposure, may also affect non-URiM students pursuing competitive specialties. However, our participants emphasized that these barriers are magnified for URiM students due to intersecting factors, including racial microaggressions, impostor syndrome related to equity admissions pathways, isolation from a lack of representation, and the additional time burden of advocacy work. Future comparative studies, including non-URiM students, would help clarify which barriers are unique to URiM students and which are shared but disproportionately impactful.

Building on participants’ insights, several key strategies can help address barriers faced by URiMs pursuing dermatology. These include creating sustained mentorship programs that connect students with mentors sharing similar backgrounds, increasing early and meaningful exposure to dermatology, and actively showcasing diversity among faculty and residents. Importantly, participants emphasized the need for programs to clearly communicate their commitment to valuing diversity, lived experiences, and the advocacy efforts of applicants. By explicitly affirming these values, programs can foster a more inclusive environment for URiMs. It is important to note that these recommendations are participant-driven and reflect the lived experiences of URiM students; they should be viewed as informed perspectives rather than empirically validated interventions. We acknowledge that dermatology residency programs face genuine structural constraints, including limited faculty time, high clinical demands, and finite residency positions. These constraints intersect with equity goals, and addressing URiM barriers will require creative solutions that operate within, or advocate for changes to, these existing structures.

Strengths and Limitations

This study has several strengths that contribute to a deeper understanding of the barriers URiMs face in pursuing dermatology in Canada. By utilizing qualitative methods, including semi-structured interviews and inductive thematic analysis, we gathered rich, in-depth data on the experiences of URiMs. The diverse perspectives within the research team helped minimize potential biases and strengthen the validity of the findings. Furthermore, heterogeneity in gender, geographical background, and trainee year enhanced the representativeness of the study sample.

However, this study has some limitations. The use of snowball sampling is appropriate to identify subjects, but may introduce selection bias. While the sample size of 24 participants is diverse, it may not fully capture the experiences of all URiMs across Canada. Our study captures the experiences of URiM medical students who are already interested in dermatology and volunteered to participate; therefore, findings may not reflect the perspectives of URiM students who have already ruled out dermatology or who chose not to participate. In addition, the reliance on self-reporting may introduce social desirability or recall biases. The majority of our participants identified as women (79.2%) and were in their first or second year of medical school (83.3%). While this reflects the demographics of our sample, the experiences of male URiM students and those in clinical clerkship years may differ. In particular, students in third and fourth year have greater exposure to dermatology rotations and the residency application process, and their perspectives would be valuable to capture in future research. Finally, the findings may not be generalized to other countries, though they offer valuable insights for similar contexts in North America.

Conclusions

This study highlights key barriers URiMs face in pursuing dermatology and provides a foundation for future research and policy changes to increase diversity in the field. Participants offered valuable recommendations to improve access to dermatology, emphasizing the importance of implementing these changes to enhance inclusivity and ultimately improve care for diverse patient populations. Future research could assess the effectiveness of these interventions and track progress in increasing URiM representation in Canadian dermatology programs.

Supplemental Material

sj-docx-1-cms-10.1177_12034754261458395 – Supplemental material for Barriers to Pursuing Dermatology in Canada: A Critical Qualitative Analysis of Medical Students from Underrepresented Backgrounds

Supplemental material, sj-docx-1-cms-10.1177_12034754261458395 for Barriers to Pursuing Dermatology in Canada: A Critical Qualitative Analysis of Medical Students from Underrepresented Backgrounds by Darshana Seeburruth, Edgar Akuffo-Addo, Eunice Aluko, Ezekiel Garuba, Ennie Olajide, Angel Osei, Jennifer Vinh Hang Tran, Veronique Lafrance, Lea Saroufim, Yvette Miller-Monthrope and Marissa Joseph in Journal of Cutaneous Medicine and Surgery