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Tsai JW, Nguyen M, Dudgeon SN, McDade W, Kim JG, Agrawal P, Boatright D. Race and Sex Disparities Among Emergency Medicine Chief Residents. JAMA Netw Open 2024; 7:e2432679. [PMID: 39316403 PMCID: PMC11423172 DOI: 10.1001/jamanetworkopen.2024.32679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Importance Physicians who belong to minoritized racial and ethnic groups remain underrepresented and underpromoted. Serving as a chief resident is an important position of leadership and prestige, and indicates a benchmark for future professional success. However, it is unknown if disparities in race and/or sex exist in the chief resident selection process. Objective To describe race, ethnicity, and sex of emergency medicine (EM) chief residents and determine the association of racial identity and the intersectionality of race and sex for selecting chief residents in US emergency medicine departments. Design, Setting, and Participants This cohort study analyzed data collected from the Association of American Medical Colleges and the Electronic Residency Application Service in the graduating classes of 2017 and 2018. Data were analyzed between December 2021 and January 2023. Main Outcomes and Measures Relative risk (RR) of selection for chief residency for Black, Asian, and Hispanic EM residents in comparison with White counterparts. Results Among 3408 studied residents, 738 (21.7%) served as chief resident (2253 male [66.1%]; 451 Asian [13.2%], 144 Black [4.2%], 158 Hispanic [4.6%], 239 more than 1 race [7.0%], 46 other [1.3%], and 2370 White [69.5%]). Of chiefs, 81 (11.0%) identified as Asian, 17 (2.3%) as Black, and 26 (3.5%) Hispanic. Asian residents were 78% (95% CI, 63%-96%) as likely to be promoted to chief resident compared with White peers, and Black residents were 51% (95% CI, 32%-80%) as likely as White residents. In our fully adjusted model, racial differences remained significant for Black residents, who were half as likely as white residents to be selected for chief residency (adjusted risk ratio [aRR], 0.55; 95% CI, 0.36-0.82). Overall, White women were most likely to be selected for chief residency and 20% more likely to be selected than White men counterparts (aRR, 1.20; 95% CI, 1.03-1.39). In comparison, women underrepresented in medicine (a category that included residents identified as Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander) were least likely to be selected for chief promotion, and 50% as likely to be selected for chief resident compared with White men (aRR, 0.50; 95% CI, 0.06-0.66). Conclusions and Relevance In this 2024 nationally representative study of EM residents, chief promotion was lower among residents identifying as Asian or Black, and in particular, women underrepresented in medicine. This study's findings suggest further review of chief resident selection process by residency programs and accreditation bodies is needed to ensure workforce equity for promotion and opportunities for leadership.
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Affiliation(s)
- Jennifer W Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- St Joseph's Medical Center, Stockton, California
| | - Mytien Nguyen
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah N Dudgeon
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jung G Kim
- Ronald O. Perelman Department of Emergency Medicine & Institute for Innovations in Medical Education, Philadelphia, Pennsylvania
- New York University Langone Health, New York
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
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Camargo A, Radmard M, Dabiri M, Carson KA, Hsu L, Yousem DM. Discrimination faced by radiology residents: an analysis of experiences and mitigation strategies. Curr Probl Diagn Radiol 2024; 53:600-605. [PMID: 38714392 PMCID: PMC11283936 DOI: 10.1067/j.cpradiol.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/09/2024]
Abstract
RATIONALE AND OBJECTIVES Literature shows that discrimination has been pervasive in the field of medicine. The aim of this study was to collect experiences related to discrimination among US radiology residents, including type and source, as well as the residents' perception on lectures about discrimination and harassment. We also explored the barriers to reporting, and suggested strategies to overcome them. MATERIAL AND METHODS Following Institutional Review Board (IRB) approval, an online survey was sent to program directors and coordinators across the US, who were asked to forward the link to their radiology residents. A reminder email was sent over a period of 4 months. The participants were reassured the survey was confidential and anonymous. RESULTS Among the respondents, the most reported types of discrimination were based in gender, race and nationality, the majority of which not being reported. The most common perpetrators were attending radiologists, co-residents, technologists, and patients. The main barriers for reporting were fear of retaliation, confidentiality concerns, and skepticism about a positive outcome. CONCLUSION Our study examines some experiences of discrimination shared by residents during their training, with gender and race being the most common causes. This sheds light into a hidden and unspoken issue and highlights the need for more active discussions in radiology on microaggressions and implicit bias. Our data can guide future studies as well as residency programs to build effective strategies to address discrimination, aiming for sustainable changes.
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Affiliation(s)
- Aline Camargo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322 USA.
| | - Mahla Radmard
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 1800 Orleans Street, Baltimore, MD, 21287 USA
| | - Mona Dabiri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 1800 Orleans Street, Baltimore, MD, 21287 USA
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205 USA
| | - Liangge Hsu
- Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115 USA
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, 1800 Orleans Street, Baltimore, MD, 21287 USA
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Smith TZ, DeYoung JK, Pum JM, Zurakowski D, Templeton K, Day CS. Odds of Attaining Orthopaedic Leadership Based on Race, Ethnicity, and Sex. J Am Acad Orthop Surg 2024:00124635-990000000-01040. [PMID: 39018573 DOI: 10.5435/jaaos-d-24-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/23/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Despite widespread acceptance of the importance of diversity in leadership, systemic challenges in leadership attainment in orthopaedic surgery still exist for several groups. We hypothesize that women, underrepresented in medicine groups, and Asians have decreased odds of achieving program director and chairperson positions compared with peers. METHODS Demographic data were collected from the Association of American Medical Colleges for faculty, program directors, and chairpersons in orthopaedic surgery. Odds ratios were calculated treating race, ethnicity, or sex as the predictor variables and attainment of a leadership position as the outcome, comparing the composition of program directors in 2020 and chairpersons in 2019 with faculty in 2019. RESULTS Significantly decreased odds were found for women at 0.37 (0.264 to 0.51 [P < 0.0001]) and the Other category at 0.16 (0.065 to 0.3864 [P = 0.0001]) while significantly increased odds were found for White and Black/African American faculty at 1.32 (1.02 to 1.71 [P = 0.0314]) and 1.95 (1.17 to 3.26 [P = 0.011]), respectively, in holding program director positions. Significantly decreased odds of attaining chairpersonship were found for women at 0.17 (0.07 to 0.41 [P = 0.0075]) and Asian faculty at 0.33 (0.14 to 0.75 [P = 0.0062]) while White faculty demonstrated significantly increased odds at 2.43 (1.41 to 4.19 [P = 0.0013]). CONCLUSIONS Women showed markedly decreased odds of leadership attainment while Black/African American faculty had increased likelihood of becoming program directors but were not markedly more likely to become chairs. Asian faculty were less likely to become program directors and markedly less likely to become chairs. While decreased odds for women were expected based on current literature, decreased odds of Asians becoming chairs and an increased likelihood of Black/African American orthopaedic surgeons becoming program directors but not attaining the role of chairs at the same rate were novel findings, revealing concerning trends for these groups.
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Affiliation(s)
- Tobin Z Smith
- From the Wayne State University School of Medicine, Detroit, MI (Smith, DeYoung, and Pum), Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA (Zurakowski), Harvard Medical School, Cambridge, MA (Zurakowski), Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS (Templeton), Department of Orthopedic Surgery at Henry Ford Health, Wayne State University School of Medicine, Detroit, MI (Day), Michigan State University College of Human Medicine, East Lansing, MI (Day)
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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Hamilton RH. Building an ethnically and racially diverse neurology workforce. Nat Rev Neurol 2024; 20:222-231. [PMID: 38388568 DOI: 10.1038/s41582-024-00941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
As diversity among patient populations continues to grow, racial and ethnic diversity in the neurology workforce is increasingly essential to the delivery of culturally competent care and for enabling inclusive, generalizable clinical research. Unfortunately, diversity in the workforce is an area in which the field of neurology has historically lagged and faces formidable challenges, including an inadequate number of trainees entering the field, bias experienced by trainees and faculty from minoritized racial and ethnic backgrounds, and 'diversity tax', the disproportionate burden of service work placed on minoritized people in many professions. Although neurology departments, professional organizations and relevant industry partners have come to realize the importance of diversity to the field and have taken steps to promote careers in neurology for people from minoritized backgrounds, additional steps are needed. Such steps include the continued creation of diversity leadership roles in neurology departments and organizations, the creation of robust pipeline programmes, aggressive recruitment and retention efforts, the elevation of health equity research and engagement with minoritized communities. Overall, what is needed is a shift in culture in which diversity is adopted as a core value in the field.
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Affiliation(s)
- Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Anderson A, Onumah C. Does Racial Bias Play a Role in Internal Medicine Resident Knowledge Evaluations? Ann Intern Med 2024; 177:95-96. [PMID: 38145567 DOI: 10.7326/m23-3141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Affiliation(s)
- Andrea Anderson
- Department of Emergency Medicine, Division of Family Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Chavon Onumah
- Department of Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Okelo SO, Chesley CF, Riley I, Diaz AA, Collishaw K, Schnapp LM, Thakur N. Accelerating Action: Roadmap for the American Thoracic Society to Address Oppression and Health Inequity in Pulmonary and Critical Care Medicine. Ann Am Thorac Soc 2024; 21:17-26. [PMID: 37934586 DOI: 10.1513/annalsats.202305-412ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Sande O Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Christopher F Chesley
- Division of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lynn M Schnapp
- American Thoracic Society, New York, New York
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Neeta Thakur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California; and
- Health Equity and Diversity Committee, American Thoracic Society, New York, New York
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8
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Gray BM, Lipner RS, Roswell RO, Fernandez A, Vandergrift JL, Alsan M. Adoption of Internal Medicine Milestone Ratings and Changes in Bias Against Black, Latino, and Asian Internal Medicine Residents. Ann Intern Med 2024; 177:70-82. [PMID: 38145569 DOI: 10.7326/m23-1588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The 2014 adoption of the Milestone ratings system may have affected evaluation bias against minoritized groups. OBJECTIVE To assess bias in internal medicine (IM) residency knowledge ratings against Black or Latino residents-who are underrepresented in medicine (URiM)-and Asian residents before versus after Milestone adoption in 2014. DESIGN Cross-sectional and interrupted time-series comparisons. SETTING U.S. IM residencies. PARTICIPANTS 59 835 IM residents completing residencies during 2008 to 2013 and 2015 to 2020. INTERVENTION Adoption of the Milestone ratings system. MEASUREMENTS Pre-Milestone (2008 to 2013) and post-Milestone (2015 to 2020) bias was estimated as differences in standardized knowledge ratings between U.S.-born and non-U.S.-born minoritized groups versus non-Latino U.S.-born White (NLW) residents, with adjustment for performance on the American Board of Internal Medicine IM certification examination and other physician characteristics. Interrupted time-series analysis measured deviations from pre-Milestone linear bias trends. RESULTS During the pre-Milestone period, ratings biases against minoritized groups were large (-0.40 SDs [95% CI, -0.48 to -0.31 SDs; P < 0.001] for URiM residents, -0.24 SDs [CI, -0.30 to -0.18 SDs; P < 0.001] for U.S.-born Asian residents, and -0.36 SDs [CI, -0.45 to -0.27 SDs; P < 0.001] for non-U.S.-born Asian residents). These estimates decreased to less than -0.15 SDs after adoption of Milestone ratings for all groups except U.S.-born Black residents, among whom substantial (though lower) bias persisted (-0.26 SDs [CI, -0.36 to -0.17 SDs; P < 0.001]). Substantial deviations from pre-Milestone linear bias trends coincident with adoption of Milestone ratings were also observed. LIMITATIONS Unobserved variables correlated with ratings bias and Milestone ratings adoption, changes in identification of race/ethnicity, and generalizability to Milestones 2.0. CONCLUSION Knowledge ratings bias against URiM and Asian residents was ameliorated with the adoption of the Milestone ratings system. However, substantial ratings bias against U.S.-born Black residents persisted. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Bradley M Gray
- American Board of Internal Medicine, Philadelphia, Pennsylvania (B.M.G., R.S.L., J.L.V.)
| | - Rebecca S Lipner
- American Board of Internal Medicine, Philadelphia, Pennsylvania (B.M.G., R.S.L., J.L.V.)
| | - Robert O Roswell
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York (R.O.R.)
| | - Alicia Fernandez
- Department of Medicine, University of California, San Francisco, San Francisco, California (A.F.)
| | - Jonathan L Vandergrift
- American Board of Internal Medicine, Philadelphia, Pennsylvania (B.M.G., R.S.L., J.L.V.)
| | - Marcella Alsan
- John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts (M.A.)
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Rigberg DA. Tailoring trainee evaluations. J Vasc Surg Venous Lymphat Disord 2023; 11:1095-1097. [PMID: 37684007 DOI: 10.1016/j.jvsv.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023]
Affiliation(s)
- David Andrew Rigberg
- Division of Vascular Surgery, Department of Surgery, University of California, Los Angeles, CA.
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Park YS, Ryan MS, Hogan SO, Berg K, Eickmeyer A, Fancher TL, Farnan J, Lawson L, Turner L, Westervelt M, Holmboe E, Santen SA. Transition to Residency: National Study of Factors Contributing to Variability in Learner Milestones Ratings in Emergency Medicine and Family Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S123-S132. [PMID: 37983405 DOI: 10.1097/acm.0000000000005366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident Milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM). METHOD Data from programs with residents entering training in July 2016 were used (EM: n=1,645 residents, 178 residency programs; FM: n=3,997 residents, 487 residency programs). Descriptive statistics were used to examine data trends. Cross-classified mixed-effects regression were used to decompose variance components in Milestones ratings. RESULTS During postgraduate year (PGY)-1, graduating medical school accounted for 5% and 6% of the variability in Milestones ratings, decreasing to 2% and 5% by PGY-3 for EM and FM, respectively. Residency program accounted for substantial variability during PGY-1 (EM=70%, FM=53%) but decreased during PGY-3 (EM=62%, FM=44%), with greater variability across training period in patient care (PC), medical knowledge (MK), and systems-based practice (SBP). Learner variance increased significantly between PGY-1 (EM=23%, FM=34%) and PGY-3 (EM=34%, FM=44%), with greater variability in practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS). CONCLUSIONS The greatest variance in Milestone ratings can be attributed to the residency program and to a lesser degree, learners, and medical school. The dynamic impact of program-level factors on learners shifts during the first year and across the duration of residency training, highlighting the influence of curricular, instructional, and programmatic factors on resident performance throughout residency.
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Affiliation(s)
- Yoon Soo Park
- Y.S. Park is head, Department of Medical Education, and The Ilene B. Harris Endowed Professor, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-8583-4335
| | - Michael S Ryan
- M.S. Ryan is associate dean for assessment, evaluation, research, and innovation, and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID: https://orcid.org/0000-0003-3266-9289
| | - Sean O Hogan
- S.O. Hogan is director of outcomes research and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0009-0008-9006-1857
| | - Katherine Berg
- K. Berg is associate dean of assessment, director, Rector Clinical Skills and Simulation Center, and professor of medicine, Sydney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Adam Eickmeyer
- A. Eickmeyer is director of medical school education, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and a PhD candidate, Maastricht University School of Health Professions Education, Maastricht, the Netherlands
| | - Tonya L Fancher
- T.L. Fancher is associate dean for workforce innovation and education quality improvement and professor of medicine, University of California, Davis, School of Medicine, Sacramento, California
| | - Jeanne Farnan
- J. Farnan is associate dean for undergraduate medical education and professor of medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Luan Lawson
- L. Lawson is senior associate dean of medical education and student affairs and professor of emergency medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Laurah Turner
- L. Turner is assistant dean for evaluation and assessment and assistant professor of medical education, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marjorie Westervelt
- M. Westervelt is director of educational assessment, scholarship, improvement, and innovation, Office of Medical Education, University of California, Davis, School of Medicine, Sacramento, California
| | - Eric Holmboe
- E. Holmboe is chief, research, milestones development and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Sally A Santen
- S.A. Santen is senior associate dean, Virginia Commonwealth University, Richmond, Virginia, and professor, emergency medicine and medical education, University of Cincinnati, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-8327-8002
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Lett E, Tran NK, Nweke N, Nguyen M, Kim JG, Holmboe E, McDade W, Boatright D. Intersectional Disparities in Emergency Medicine Residents' Performance Assessments by Race, Ethnicity, and Sex. JAMA Netw Open 2023; 6:e2330847. [PMID: 37733347 PMCID: PMC10514741 DOI: 10.1001/jamanetworkopen.2023.30847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/19/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments. Objective To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments. Design, Setting, and Participants This retrospective cohort study used data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education Milestones (Milestones) assessments to evaluate ratings for EM residents at 128 EM training programs in the US. Statistical analyses were conducted in June 2020 to January 2023. Exposure Training and assessment environments in EM residency programs across comparison groups defined by ethnoracial identity (Asian, White, or groups underrepresented in medicine [URM], ie, African American/Black, American Indian/Alaska Native, Hispanic/Latine, and Native Hawaiian/Other Pacific Islander) and sex (female/male). Main Outcomes and Measures Mean Milestone scores (scale, 0-9) across 6 core competency domains: interpersonal and communications skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and system-based practice. Overall assessment scores were calculated as the mean of the 6 competency scores. Results The study sample comprised 128 ACGME-accredited programs and 16 634 assessments for 2708 EM residents of which 1913 (70.6%) were in 3-year and 795 (29.4%) in 4-year programs. Most of the residents were White (n = 2012; 74.3%), followed by Asian (n = 477; 17.6%), Hispanic or Latine (n = 213; 7.9%), African American or Black (n = 160; 5.9%), American Indian or Alaska Native (n = 24; 0.9%), and Native Hawaiian or Other Pacific Islander (n = 4; 0.1%). Approximately 14.3% (n = 386) and 34.6% (n = 936) were of URM groups and female, respectively. Compared with White male residents, URM female residents in 3-year programs were rated increasingly lower in the medical knowledge (URM female score, -0.47; 95% CI, -0.77 to -0.17), patient care (-0.18; 95% CI, -0.35 to -0.01), and practice-based learning and improvement (-0.37; 95% CI, -0.65 to -0.09) domains by postgraduate year 3 year-end assessment; URM female residents in 4-year programs were also rated lower in all 6 competencies over the assessment period. Conclusions and Relevance This retrospective cohort study found that URM female residents were consistently rated lower than White male residents on Milestone assessments, findings that may reflect intersectional discrimination in physician competency evaluation. Eliminating sex-specific ethnoracial disparities in resident assessments may contribute to equitable health care by removing barriers to retention and promotion of underrepresented and minoritized trainees and facilitating diversity and representation among the emergency physician workforce.
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Affiliation(s)
- Elle Lett
- Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nguyen Khai Tran
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California
| | - Nkemjika Nweke
- St George’s University School of Medicine, St George, Grenada
| | | | - Jung G. Kim
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, New York University, New York
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Yang DH, Justen M, Lee D, Kim H, Boatright D, Desai M, Tiyyagura G. Experiences with Racism Among Asian American Medical Students. JAMA Netw Open 2023; 6:e2333067. [PMID: 37695582 PMCID: PMC10495868 DOI: 10.1001/jamanetworkopen.2023.33067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students. Objective To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment. Design, Setting, and Participants This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years. Main Outcomes and Measures The medical school experiences of Asian American medical students. Results Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future. Conclusions and Relevance In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.
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Affiliation(s)
- David H. Yang
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Marissa Justen
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Dana Lee
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Heeryoung Kim
- Department of Psychiatry, Middlesex Hospital, Middletown, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University School of Medicine, New York
| | - Miraj Desai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gunjan Tiyyagura
- Department of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Carter K, Ahn J. A systematic approach to tackling racism in emergency medicine: A commentary on the executive summary of the SAEM 2022 consensus conference. Acad Emerg Med 2023; 30:782-785. [PMID: 37102988 DOI: 10.1111/acem.14746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Keme Carter
- Section of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois, USA
- Biological Sciences Division, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - James Ahn
- Section of Emergency Medicine, University of Chicago Medicine, Chicago, Illinois, USA
- Biological Sciences Division, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
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