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Hauc SC, Rivera JC, Pondugula N, Febre-Alemañy DA, Jayaraj C, Goss JA, Butler PD. A 10-year analysis of the racial distribution of authors in plastic surgery research and the impact of minority mentorship. Am J Surg 2024; 236:115744. [PMID: 38658268 DOI: 10.1016/j.amjsurg.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/24/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND This study evaluates the racial distribution in Plastic and Reconstructive Surgery (PRS) publication authorship and illustrates the impact underrepresented in medicine (URiM) mentorship has on increasing diverse trainee contributions to the PRS peer-reviewed literature. METHODS Articles published in the seven highest-impact PRS peer-reviewed journals within the last 10 years (2012-2022) were reviewed and analyzed for first and senior authors' race and ethnicity, publication year, and citation count. RESULTS A total of 23,549 publications were identified of which 8250 were from the US-based institutions. A random sampling of 778 publications (∼10 %) were scrutinized for first and senior author race and ethnicity. Across all journals, 64.5 % of senior authors were White, 29.9 % Asian, 4.6 % Hispanic, and 1.0 % Black. First authors were 59.5 % White, 32.8 % Asian, 5.2 % Hispanic, and 2.6 % Black (p=<0.0001). The presence of a URiM senior author increased the likelihood of a URiM first author 7-fold (p=<0.0001); 95 % CI [3.5-14.0]). There was no statistically significant difference in the total citation count relative to author race or ethnicity. The Aesthetic Surgery Journal had the greatest proportion of White senior authors (73.6 %), while Microsurgery had the highest percentage of URiM senior authors (8.7 %). CONCLUSIONS URiM authorship of PRS publications is limited and mentorship is essential to improve underrepresented perspectives in the PRS peer-reviewed literature.
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Affiliation(s)
- Sacha C Hauc
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jean Carlo Rivera
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Nishita Pondugula
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - David A Febre-Alemañy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Christina Jayaraj
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy A Goss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Paris D Butler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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Brady N, Peck C, Anderson C, Shamim A, Kersh L, Gondi I, Rollins A, Subhedar S, Jayaram A, Hauser B, Hill S, Wariso B, Rehman S, Clune J. Characteristics and Experiences Associated with Interest in Global Surgery: What Brings US Medical Students to the Field? JOURNAL OF SURGICAL EDUCATION 2024; 81:1258-1266. [PMID: 39013668 DOI: 10.1016/j.jsurg.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/08/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION An estimated 5 billion people lack access to safe surgical care. Development and nurturing of medical student interest in global surgery can play a part in addressing this need. This study examines characteristics and experiences of medical students in the United States (US) associated with interest in global surgery. METHODS A cross-sectional survey study of US-based medical students was performed. Student leaders from the Global Surgery Student Alliance were recruited via email and distributed the online survey to peers at their institutions. Responses from students currently training outside of the US were excluded, as were surveys with <80% completion. Descriptive statistics and multivariate analysis were performed with p < 0.05 indicating significance in R (Vienna, Austria). RESULTS About 708 responses from students at 38 US medical schools were analyzed. 251 students (34.6%) identified as being interested in global surgery. After adjusting for covariates on multivariable regression, demographic factors significantly associated with interest in global surgery were Hispanic/Latino ethnicity (in comparison to Non-Hispanic White/Caucasian, OR = 1.30) and being born outside of the United States (OR = 1.21). Increased interest was also associated with previous clinical experiences in low or middle-income countries (OR = 1.19), public or global health experiences (OR = 1.18), and international service experiences (OR = 1.13). CONCLUSIONS While many factors may influence student interest in global surgery, previous global health experience and nonclinical global service work are important predictors regardless of background. Our results suggest that medical educators should look to both international clinical and nonclinical collaborations as a means to cultivate and nourish global surgery interest in medical students.
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Affiliation(s)
- Noah Brady
- Harvard School of Dental Medicine, Boston, Massachusetts.
| | - Connor Peck
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | | | - Abrar Shamim
- Columbia University College of Dental Medicine, New York, New York
| | - Lydia Kersh
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | | | - Allison Rollins
- Department of Otolaryngology-Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Anusha Jayaram
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Sarah Hill
- University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
| | - Bathsheba Wariso
- Department of Obstetrics and Gynecology, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Shahyan Rehman
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James Clune
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Connecticut
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Nguyen M, Gonzalez L, Stain SC, Dardik A, Chaudhry SI, Desai MM, Boatright D, Butler PD. Association of Socioeconomic Status, Sex, Racial, and Ethnic Identity With Sustained and Cultivated Careers in Surgery. Ann Surg 2024; 279:367-373. [PMID: 37470162 PMCID: PMC10799171 DOI: 10.1097/sla.0000000000006029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Examine the association between sex, race, ethnicity, and family income, and the intersectionality between these identities, and sustained or cultivated paths in surgery in medical school. METHODS This retrospective cohort study examines US medical students who matriculated in academic years 2014-2015 and 2015-2016. Data were provided by the Association of American Medical Colleges, including self-reported sex, race, ethnicity, family income, interest in surgery at matriculation, and successful placement into a surgical residency at graduation. This study examined 2 outcomes: (1) sustained path in surgery between matriculation and graduation for students who entered medical school with an interest in surgery and (2) cultivated path in surgery for students who entered medical school not initially interested in surgery and who applied to and were successfully placed into a surgical residency at graduation. RESULTS Among the 5074 students who reported interest in surgery at matriculation, 2108 (41.5%) had sustained path in surgery. Compared to male students, female students were significantly less likely to have sustained path in surgery [adjusted relative risk (aRR): 0.92 (0.85-0.98)], while Asian (aRR: 0.82, 95% CI: 0.74-0.91), Hispanic (aRR: 0.70, 95% CI: 0.59-0.83), and low-income (aRR: 0.85, 95% CI: 0.78-0.92) students were less likely to have a sustained path in surgery compared to their peers. Among the 17,586 students who reported an initial interest in a nonsurgical specialty, 1869 (10.6%) were placed into a surgical residency at graduation. Female students, regardless of race/ethnic identity and income, were significantly less likely to have cultivated paths in surgery compared to male students, with underrepresented in medicine female students reporting the lowest rates. CONCLUSIONS AND RELEVANCE This study demonstrates the significant disparity in sustained and cultivated paths in surgery during undergraduate medical education. Innovative transformation of the surgical learning environment to promote surgical identity development and belonging for females, underrepresented in medicine, and low-income students is essential to diversify the surgical workforce.
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Affiliation(s)
| | | | - Steven C Stain
- Department of Surgery, Lahey Hospital and Medical Center, Boston, MA
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT
- Department of Surgery, VA Connecticut Healthcare System, West Haven, CT
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Dowin Boatright
- Department of Emergency Medicine, New York University School of Medicine, New York, NY
| | - Paris D Butler
- Department of Surgery, Yale School of Medicine, New Haven, CT
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Chisolm DJ, Dugan JA, Figueroa JF, Lane‐Fall MB, Roby DH, Rodriguez HP, Ortega AN. Improving health equity through health care systems research. Health Serv Res 2023; 58 Suppl 3:289-299. [PMID: 38015859 PMCID: PMC10684038 DOI: 10.1111/1475-6773.14192] [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] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. DATA SOURCES AND STUDY SETTING This project was conducted as a component of the Agency for Healthcare Research and Quality's (AHRQ) stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. Recommendations were developed and refined based on expert input, evidence review, and stakeholder engagement. Participating stakeholders included experts from academia, health care organizations, industry, and government. STUDY DESIGN Expert group consensus, informed by stakeholder engagement and targeted evidence review. DATA COLLECTION/EXTRACTION METHODS Priority themes were derived iteratively through (1) brainstorming and idea reduction, (2) targeted evidence review of candidate themes, (3) determination of preliminary themes; (4) input on preliminary themes from stakeholders attending AHRQ's 2022 Health Equity Summit; and (5) and refinement of themes based on that input. The final set of research and action recommendations was determined by authors' consensus. PRINCIPAL FINDINGS Health care delivery systems have contributed to racial and ethnic disparities in health care. High quality research is needed to inform health care delivery systems approaches to undo systemic barriers and inequities. We identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. We also suggest cross-cutting themes regarding research workforce and research timelines. CONCLUSIONS As the nation's primary health services research agency, AHRQ can advance equitable delivery of health care by funding research and disseminating evidence to help transform the organization and delivery of health care.
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Affiliation(s)
- Deena J. Chisolm
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Department of PediatricsThe Ohio State University College of MedicineColumbusOhioUSA
| | - Jerome A. Dugan
- Department of Health Systems and Population Health, School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Jose F. Figueroa
- Harvard T.H. Chan School of Public HealthBrigham and Women's HospitalCambridgeMassachusettsUSA
| | - Meghan B. Lane‐Fall
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine and Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dylan H. Roby
- Department of Health, Society, and Behavior, Program in Public HealthUniversity of California, IrvineIrvineCaliforniaUSA
| | - Hector P. Rodriguez
- Division of Health Policy and Management, School of Public HealthUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | - Alexander N. Ortega
- Department of Health Management and Policy, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
- Present address:
Thompson School of Social Work & Public HealthUniversity of Hawaii at ManoaHonoluluHawaiiUSA
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Hernandez M, Ibiwoye MO, Ledbetter M, Thacker R, Diaz S. Building Interest in the Primary Care Specialty Through Enhanced Global Health Experience. Cureus 2023; 15:e50216. [PMID: 38192912 PMCID: PMC10773161 DOI: 10.7759/cureus.50216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Background An overwhelming majority of matriculating medical students in the USA are keen to deliver quality health care to all people, including the socioeconomically disadvantaged populations in remote, resource-scarce regions nationally and worldwide. Here, we describe a protocol developed to evaluate the interest of our medical students in global health activities. We also examined the relationship between students' interest in global health and readiness to pursue a future career in the primary care specialty. Materials and methods We designed a survey in Qualtrics online software and reached all first-year and third-year medical students between 2019 and 2022 enrolled at the Alabama College of Osteopathic Medicine (ACOM). The survey utilized ordinal scale items to explore the medical students' interest in primary care residency programs, their interest in global health and international travel, and their perceptions of how a range of factors might motivate their desire to participate in global health activities. The study was approved by ACOM's Institutional Review Board (IRB). In order to compare findings from this study with data from other medical schools, we developed constructs using the national aggregate data, in percentages, from matriculants and graduates of Doctor of Osteopathic Medicine (DO) degree-granting medical schools according to gender, published by the American Association of Colleges of Osteopathic Medicine (AACOM). Statistical analysis of national aggregate data was performed using the unpaired t-test. Results Both female and male participants had lived or traveled abroad before starting medical school. Female (98%, n=249) and male (95%, n=140) participants in the first-year cohorts considered helping the underserved population as important or very important as it is related to a career in medicine. Females in the third-year cohorts (97%, n=71) also ranked this statement as important or very important compared to male cohorts (89%, n=31). A higher proportion of females (43%, n=108) compared to males (35%, n=52) in first-year cohorts agreed or strongly agreed that they would likely pursue a residency in primary care. More females (59%, n=43) than males (46%, n=16) in the third-year cohorts agreed or strongly agreed with the same statement. Analysis of the aggregate national data (2009-2022) revealed that the percentage (actual count not available) of female students who planned to practice in underserved/shortage area was higher both at the time of matriculation (M=51%, SD=4%) and before graduation (M=40%, SD=4%) compared to males (matriculation: M=40%, SD=5%; graduation: M=33%, SD=4%) presenting a significant difference (matriculation t(24)=6.7, p<0.0001; graduation t(24)=5.4, p<0.0001). Furthermore, a higher percentage of females at the time of matriculation (M=25%, SD=5%) and graduation (M=40%, SD=6%) planned to practice in the primary care specialties compared to males (matriculation: M=17%, SD=4%; graduation: M=29%, SD=6%) presenting a significant difference (matriculation: t(24)=4.6, p = 0.0001; graduation: t(24)=4.8, p<0.0001). Conclusions Interest in global health activities may be associated with interest in pursuing a future career in the primary care specialty. In this study, more female medical students expressed interest in participating in global health experiences, serving the underserved population domestically and abroad, and expressing interest in primary care than males.
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Affiliation(s)
- Mark Hernandez
- Medical Education, Quillen College of Medicine, Johnson City, USA
| | - Michael O Ibiwoye
- Anatomy Department, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Melinda Ledbetter
- Clinical Sciences, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Richard Thacker
- Clinical Sciences, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Sebastian Diaz
- Medical Education, Northeast Ohio Medical University, Rootstown, USA
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Nguyen M, Kaminaka A, Brutus NN, Gonzalez LA, Ratanpal A, Alperovich M, Jeffe DB, Ata A, Mason HRC, Butler PD. Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5177. [PMID: 37577250 PMCID: PMC10419697 DOI: 10.1097/gox.0000000000005177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/22/2023] [Indexed: 08/15/2023]
Abstract
Improving the number of plastic and reconstructive surgeons who provide care to patients in underserved communities is critical to achieving health equity. We aimed to identify factors associated with graduating medical students' intentions to pursue plastic surgery and practice in underserved areas. Methods De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas. Results Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas. Conclusions Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.
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Affiliation(s)
- Mytien Nguyen
- From the School of Medicine, Yale University, New Haven, Conn
| | | | | | | | | | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Donna B. Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | | | | | - Paris D. Butler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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Martinez S, Rrapi E, Hacker MR, Nguyen M, Jeffe DB, Capellan A, McKinney S. Student intentions to pursue obstetrics and gynecology training and practice in underserved areas. Am J Obstet Gynecol 2023; 228:242-246.e2. [PMID: 36116522 PMCID: PMC10431753 DOI: 10.1016/j.ajog.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/19/2022] [Accepted: 09/11/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Sarah Martinez
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | | | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | | | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | | | - Sara McKinney
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
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Cerasani M, Omoruan M, Rieber C, Nguyen M, Mason HR, Clair B, Stain SC, Mason AR, Levin LS. Demographic Factors and Medical School Experiences Associated with Students' Intention to Pursue Orthopaedic Surgery and Practice in Underserved Areas. JB JS Open Access 2023; 8:JBJSOA-D-22-00016. [PMID: 36698985 PMCID: PMC9851675 DOI: 10.2106/jbjs.oa.22.00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Physician shortages across the United States will affect access to orthopaedic care for patients. Orthopaedic surgery is predicted to have one of the largest shortages among surgical subspecialties by 2025, which will disproportionally affect patients in medically underserved areas. This study examines characteristics and experiences of graduating medical students interested in orthopaedic surgery who intend to practice in underserved areas (IPUAs). Methods We analyzed deidentified data of AAMC Graduation Questionnaire respondents who matriculated between 2007 to 2008 and 2011 to 2012. Forty-eight thousand ninety-six (83.91%) had complete demographic, financial, and medical school elective data and were included in the study cohort. Multivariable logistic regression was performed to determine the correlation between student characteristics and intention to pursue orthopaedic surgery and IPUAs. Results Of the 48,096 students with complete information, 2,517 (5.2%) intended to pursue a career in orthopaedic surgery. Among the orthopaedic students, men were less likely than women to report IPUAs (adjusted odds ratio [aOR], 0.6; 95% CI, 0.4-0.8). Students who identified as Black/African American (aOR, 5.0; 95% CI, 3.0-8.2) or Hispanic (aOR, 2.0; 95% CI, 1.1-3.5) were more likely than White students to report IPUAs. Medical students who intend to pursue orthopaedics and received a scholarship (aOR, 1.5; 95% CI, 1.1-2.0), participated in community research (aOR, 1.8; 95% CI, 1.4-2.3), or had a global health experience (aOR, 1.9; 95% CI, 1.5-2.5) were more likely to report IPUAs. Discussion If orthopaedic surgeons who reported as medical students who reported IPUAs actually do so, recruiting and retaining more sex and race/ethnically diverse orthopaedic surgeons could reduce the impact of the impending shortage of orthopaedic surgeons in underserved areas. IPUA is correlated to medical school experiences related to cultural competency including global health experiences and community-based research projects.
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Affiliation(s)
| | - Moje Omoruan
- SUNY Upstate Medical University, Syracuse, New York
| | | | - Mytien Nguyen
- MD-PhD Program, Yale University School of Medicine, New Haven, Connecticut
| | | | - Brian Clair
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Steven C. Stain
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Amadeus R. Mason
- Department of Orthopaedic Surgery and Family Medicine at Emory University, Atlanta, Georgia
| | - L Scott Levin
- Department of Orthopaedic Surgery, Department of Surgery (Division of Plastic Surgery) Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,E-mail address for L.S. Levin:
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Nguemeni Tiako MJ, Johnson S, Muhammad M, Osman NY, Solomon SR. Association Between Racial and Ethnic Diversity in Medical Specialties and Residency Application Rates. JAMA Netw Open 2022; 5:e2240817. [PMID: 36367730 PMCID: PMC9652751 DOI: 10.1001/jamanetworkopen.2022.40817] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE The lack of racial and ethnic diversity in the US medical profession is a well-recognized problem, and racial and ethnic representation is highly variable across the medical specialties. Residency selection is a crucial juncture at which diversity and representation in specialties can be increased. OBJECTIVE To identify factors associated with residency application rates for medical specialties by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional study of medical student residency applications used American Association of Medical Colleges data on 2019-2020 applicants and information about the racial and ethnic characteristics of practicing physicians (including medical school faculty) and department chairs. A total of 26 320 applicants to medical residency programs, 592 296 practicing physicians, and 2121 department chairs across the US were included. Residency application rates for 18 medical specialties were evaluated. MAIN OUTCOMES AND MEASURES The main outcome was the specialty representation quotient (SRQ), which estimated the extent to which students from a racial or ethnic group were overrepresented (an SRQ >1) or underrepresented (an SRQ <1) in a given specialty compared with the racial and ethnic demographic characteristics of the corresponding graduating class. Covariates included the racial and ethnic demographic characteristics of practicing physicians and department chairs by specialty based on American Association of Medical Colleges data and student academic factors (mean United States Medical Licensing Examination step 1 score, number of research experiences, and AΩA honor society membership among matched students from the previous application cycle). Multivariable logistic regression analysis was used to examine associations between these covariates and application rates by race and ethnicity. RESULTS Among 26 320 specialty-specific applications to medical residency programs in 18 specialties, 90 (0.3%) were from American Indian or Alaska Native students, 6718 (25.5%) were from Asian students, 2575 (9.8%) were from Black students, 1896 (7.2%) were from Hispanic students, and 15 041 (57.1%) were from White students. Among 592 296 practicing physicians, 2777 (0.5%) were American Indian or Alaska Native, 117 358 (19.8%) were Asian, 36 639 (6.2%) were Black, 41 071 (6.9%) were Hispanic, and 394 451 (66.6%) were White. Among 2121 department chairs, 5 (0.2%) were American Indian or Alaska Native, 212 (10.0%) were Asian, 86 (4.1%) were Black, 88 (4.1%) were Hispanic, and 1730 (81.6%) were White. The specialties with the greatest representation among applicants from racial and ethnic groups underrepresented in medicine (URM) were family medicine (SRQ, 1.70), physical medicine and rehabilitation (SRQ, 1.60), and obstetrics and gynecology (SRQ, 1.47). The specialties with the lowest URM representation among applicants were plastic surgery (SRQ, 0.47), otolaryngology (SRQ, 0.53), and orthopedic surgery (SRQ, 0.86). Membership in AΩA was negatively associated with SRQ among American Indian or Alaska Native students only (β = -0.11; 95% CI, -0.17 to -0.05; P = .002). Racial and ethnic representation among practicing physicians was positively associated with SRQ for American Indian or Alaska Native students (β = 6.05; 95% CI, 4.26-7.85; P < .001), Asian students (β = 0.07; 95% CI, 0.06-0.09; P < .001), Black students (β = 0.10; 95% CI, 0.06-0.15; P < .001), and URM students overall (β = 0.05; 95% CI, 0.01-0.08; P = .02). CONCLUSIONS AND RELEVANCE This study's findings suggest that the propensity of medical students, particularly those from racial and ethnic minority groups, to apply to a given specialty for residency was associated with the representation of their racial or ethnic group among the specialty's practicing physicians. Future work to characterize the mechanisms of occupational sorting may guide interventions to improve equity within the physician workforce.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Shawn Johnson
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Nora Y. Osman
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sonja R. Solomon
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Barrie U, Williams M, Nguyen M, Kenfack YJ, Mason H, Ata A, Aoun SG, Pilitsis JG. Characteristics of graduating medical students interested in neurosurgery with intention to practice in underserved areas: Implications for residency programs. Clin Neurol Neurosurg 2022; 218:107293. [DOI: 10.1016/j.clineuro.2022.107293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
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Xu S, Wang J, Wang Y, Wang M, Huang X, Huang H. Individuals' Awareness of and Willingness to Accept Hospital-at-Home Services and Related Factors: A Cross-Sectional Study. Front Public Health 2022; 10:823384. [PMID: 35692306 PMCID: PMC9184713 DOI: 10.3389/fpubh.2022.823384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHospital-at-home (HaH) services have become increasingly popular. However, the experience of HaH implementation in Asia is inadequate. Therefore, the purpose of this study was to investigate individuals' willingness to accept HaH services and the potential related factors.MethodsThe researchers visited households to select appropriate participants. An online questionnaire survey was conducted among the inhabitants of selected communities. An individual's awareness, willingness to accept HaH services, and demands such as ideal service providers and more detailed information to accept HaH care were investigated. The outcome measure was the willingness to accept HaH services. Chi-square tests and logistic regression models were used to analyze the factors.ResultsA total of 622 subjects participated in this study. The findings indicate that 55.9% of the participants were not aware of HaH services, while most of the subjects (88.4%) were willing to accept them. Regression models indicated that having health insurance (OR = 2.170, 95% CI: 1.003–4.697), an awareness of the necessity of HaH services (OR = 4.721, 95% CI: 2.471–9.019), very much hoping staff from central hospitals would be service providers (OR = 20.299, 95% CI: 5.718–72.068), and somewhat hoping that staff from central hospitals would be service providers (OR = 9.139, 95% CI: 2.714–30.775) were the factors associated with a greater willingness to accept HaH services.ConclusionThe study indicates that compared to the awareness of HaH care, residents had a greater willingness to accept such care. The willingness to utilize HaH services among individuals was associated with enabling factors, predisposing factors, and HaH-related demand factors.
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Affiliation(s)
- Siyu Xu
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jingjun Wang
- West China School of Nursing, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ya Wang
- West China School of Nursing, Sichuan University, Chengdu, China
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Mengmeng Wang
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xia Huang
- West China School of Nursing, Sichuan University, Chengdu, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Huang
- West China School of Nursing, Sichuan University, Chengdu, China
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hao Huang
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