Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds

Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program

BACKGROUND

There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI.

OBJECTIVE

Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles.

METHODS

IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory.

RESULTS

14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles.

CONCLUSIONS

LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.

Examining the Role of Gender and Ethnic Concordance in Medical Student Specialty Selection

Introduction

Representation of female and minority physicians varies across specialties and may influence career selection by medical students. To investigate the effect of demographic concordance between medical students and clinical role models on specialty selection, we conducted a survey of graduating medical students to assess the perceived importance and influence of third-year clerkship experiences with demographically concordant preceptors on their choice of specialty for post-graduate training.

Methods

An 11-question survey was shared nationally through AAMC Organizational Student Representatives to medical students in the Class of 2023. Information gathered included demographics; specialty of choice; extent of exposure to preceptors of the same gender, race, or ethnicity during clinical clerkships; and perceived importance and influence of those interactions (Likert 1-5, Low-High) on specialty selection.

Results

A total of 84 students responded. Female students ascribed more importance to gender concordance with preceptors on the third-year clerkship most associated with their specialty of choice than males [3.4 (SD 1.2) vs. 1.3 (SD 0.8) respectively, p < 0.0001] and greater influence to gender concordance on final specialty selection [2.37 (SD 1.1) vs. 1.31 (SD 0.8) respectively, p < 0.0001]. Non-Caucasians ascribed more importance to race/ethnicity concordance than Caucasians [2.8 (SD 1.4) vs. 1.2 (SD 0.5) respectively, p < 0.0001] and greater influence to race/ethnicity concordance on final specialty selection [2.0 (SD 1.3) vs. 1.1 (SD 0.4) respectively, p < 0.0001]. Caucasian females ascribed the greatest importance to gender concordance (p < 0.001), non-Caucasian females ascribed the greatest influence of gender concordance (p < 0.001), and non-Caucasian females ascribed both the greatest importance (p < 0.001) and influence (p < 0.001) to race/ethnicity concordance.

Conclusions

We found that gender and race/ethnicity concordance between students and clinical preceptors during third year clerkships is perceived as especially important and influential in specialty selection by minority and female medical students. These findings highlight the importance of diversity in gender and race/ethnicity representation by preceptors on clinical clerkships.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02044-6.

Mentoring as a complex adaptive system - a systematic scoping review of prevailing mentoring theories in medical education

BACKGROUND

Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring's personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS).

METHODS

A systematic scoping review using Krishna's Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion.

RESULTS

Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring's CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes.

CONCLUSION

Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.

Enhancing Our Workforce: Recruitment and Retention in Anesthesiology

Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.

Increasing Diversity in Academic Medicine Via a Strategic Intermural Housestaff Leadership Development Program

PROBLEM

By 2055, the United States will no longer have a single race or ethnic majority. As the nation's demographics change, the field of medicine must also change to meet the needs of diverse patients.

APPROACH

In 2013, UT Southwestern Medical Center implemented the Housestaff Emerging Academy of Leaders (HEAL) program, which provides leadership development skills and training to underrepresented in medicine physician residents in preparation for academic medicine careers. Program leaders hypothesized that by providing housestaff with structured mentorship, career coaching, and individualized development plans, HEAL would increase interest in pursuing academic careers and prepare residents for faculty positions. HEAL has since expanded to graduate medical education programs nationwide.

OUTCOMES

From 2013 to 2018, HEAL included housestaff at UT Southwestern and other Texas medical centers, totaling 392 enrollees. In 2019, the program increased to include housestaff from around the country. The first HEAL USA program had 39 housestaff, which increased to 173 in 2019, including 60 faculty from 31 U.S. academic medical centers. The 2019 HEAL USA preassessment survey (32 trainee responses) revealed that 10 (31%) of the housestaff were "extremely interested" in academic medicine, but only 1 (3%) felt "extremely confident" to pursue an academic medicine career. Postassessment responses to these same items (5 trainee responses) were 3 (60%) and 1 (20%), respectively, with 3 (60%) also feeling "extremely prepared" (1 [20%]) or "very prepared" (2 [40%]) to pursue an academic medicine career. Of 70 evaluable participants who attended at least 2 sessions and have graduated from residency, 47 (67%) have attained academic faculty positions, whereas 23 (33%) have pursued positions at nonacademic centers.

NEXT STEPS

The next steps for HEAL USA will be continued expansion to additional medical centers and effective delivery of career development and leadership training to encourage participants to pursue academic medical careers.

Designing Prefaculty Competencies for Diverse Learners Through a Modified Delphi Process

Importance

Faculty diversity in academic medicine may better prepare the next generation of equity-minded health care practitioners and leaders. Prefaculty development is an emerging concept to support trainees in achieving key knowledge, skills, and experiences to become successful faculty.

Objective

To outline competencies, with corresponding milestones, to support the academic career development of learners, inclusive of racial, ethnic, sexual, and gender identities minoritized in medicine.

Design, Setting, and Participants

Using a modified Delphi process, a national working group consisting of 13 members was established. The group used the published literature and listening sessions with diverse stakeholders to draft a set of competencies and milestones in July 2022. Diverse expert panelists reviewed the draft set over 2 rounds between September 2022 and January 2023. The group considered qualitative data to further refine the draft set between rounds. Consensus was reached when competencies and milestones were rated as agree or strongly agree on importance or appropriateness by 75% or greater of expert panelists after the second round. A final set of competencies and milestones was generated in February 2023. Data from round 1 were analyzed in October 2022 and data from round 2 were analyzed in January 2023.

Main Outcomes and Measures

The development of prefaculty competencies with corresponding milestones by expert panel rankings and comments.

Results

The national working group consisted of 13 members who represented diversity across racial, ethnic, and gender identities and academic and career tracks. The working group developed an initial set of 36 competencies and corresponding milestones across 12 domains. After 2 rounds, consensus among 46 expert panelists generated a final list of 32 competencies with corresponding milestones across 11 domains. A total of 26 panelists (56.5%) were women, 11 (23.9%) were Black or African American, 17 (37.0%) were Latina/o/x/e, Hispanic, or of Spanish origin, and 10 (21.7%) were White. Competency domains were divided into 2 groups: foundational (academic career choice and professional identity, mentorship, networking, financial skills, diversity and inclusion, personal effectiveness and self-efficacy, and leadership) and focused (education, community engagement, research, and clinical medicine). Consensus for inclusion or elimination of items was greater than 90% between the 2 rounds.

Conclusions and Relevance

There was consensus among the working group and expert panelists regarding the importance and appropriateness of the competencies and milestones for diverse trainees to successfully obtain faculty positions. Institutions and national organizations can use these competencies as a framework to develop curricula that support diverse learners' career development toward academia.

Creating an Undergraduate Research Program in Otolaryngology-Head and Neck Surgery (Oto-HNS) for Students Underrepresented in Medicine

Objectives

To report implementation and outcomes associated with a novel paid Summer Undergraduate Research Education Program (SREP) over the first 2 years in an academic otolaryngology program recruiting students underrepresented in medicine (URiM).

Methods

A 10-week program including a research bootcamp, curriculum, mentoring, and clinical shadowing was created. Grant funding to provide salary and support for transportation, conference attendance, and graduate school preparation or applications was procured. Primary objectives included (1) development of successful mentorship relationships; (2) increasing student-reported outcomes using pre- and post-program surveys to assess confidence, career planning, and overall satisfaction; (3) increasing exposure to medicine; (4) completion of an oral presentation; and (5) submission of a manuscript. Secondary objectives included abstract submission and completion of a graduate exam course or graduate school applications. Tertiary objectives included conference attendance and graduate school matriculation.

Results

One hundred thirty-five total applications were reviewed (89 from year 1 and 46 from year 2). Twelve students were interviewed for 3 spots in year 1, while 11 students were interviewed for 6 spots in year 2 (median application score, 9.25 (range, 1-14); median interview score, 8.7 (range, 5.4-10); acceptance rate, 6.7% (9/135)). Students met all primary objectives. Mean program survey scores increased from 3.8 to 4.77 (p < 0.0001). Eight of nine students submitted an abstract to a national conference, with five of eight students accepted for a presentation. Two students were accepted into graduate school, while five others are on track for graduate school application.

Conclusion

Identifying mentors, curriculum, and opportunities to meaningfully strengthen graduate school applications for URiM students through a clinically rigorous, financially supported, and research-focused summer program in an academic otolaryngology program is feasible and may be an effective means of increasing diversity in medicine and otolaryngology.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02021-z.

Need for Time and Training: Pediatric Program Directors' Perceptions About Mentorship of Residents

OBJECTIVE

We aimed to describe pediatric program directors' perceptions of existing mentorship programs in pediatric residencies, to assess whether characteristics used for mentor-mentee assignments impact mentoring outcomes, and to identify barriers to success in mentorship programs.

METHODS

With the support of the Association of Pediatric Program Directors (APPD) Research Task Force, we conducted a cross-sectional survey study of all associate pediatric program directors in the United States in March 2022.

RESULTS

Nearly half (82 of 197, 41.6%) of programs responded. Most (87.8%) report having a formal mentoring program. Half of programs (51.4%) do not provide training to residents on how to be a mentee, and only slightly more than half (62.5%) provide training to faculty mentors. Most programs (80.6%) do not provide protected time for faculty mentors. There were no meaningful associations with characteristics used for mentorship matches and perceived successful mentorship. Top barriers from the program leadership perspective included faculty and residents lacking time, residents lacking skills to be proactive mentees, and inadequate funding.

CONCLUSIONS

While a majority of programs have formal mentorship programs, many do not provide training to mentors or mentees. Barriers to mentorship include a lack of funding and time. National organizations, such as APPD and the Accreditation Council for Graduate Medical Education, have an opportunity to provide guidance and support for protected time, funding, and training for mentors and mentees.

Representation of Women Authorship in the Top 5 Transplantation Journals in the United States

BACKGROUND

In the United States, only 13% of transplant surgeons are women. We evaluated gender distribution and trends of American authorship over the past 10 y in high-impact solid organ transplantation journals to gain insight into the current status of women authorship in transplantation.

METHODS

Original articles from 2012 to 2021 from the 5 highest-impact solid organ transplantation journals were extracted from Scopus. First and last author's gender was predicted using Genderize.io. Data of first and last authors, article type and topic, location, citation, and funding metrics were analyzed. Chi-square, logistic regression, and trend tests were performed where appropriate. Statistical significance was set at <0.05.

RESULTS

Women's first and last authorship increased over time among all journals. There was an increase in women first authors in the American Journal of Transplantation and in senior women authors in Liver Transplantation and Transplantation . Significant differences in gender authorship in lung, intestine, pancreas, general, and islet cell transplantation were found. Women's last authorship was associated with 1.69 higher odds of having a woman first author when adjusting for year and journal. There was an increase in the rate of women's first and last author collaborations over the years. Women last authors had 1.5 higher odds of being funded by the National Institutes of Health over the years.

CONCLUSIONS

Despite an increase in women transplant surgeons and physicians, the gap in women authorship in transplantation persists. Women's last authorship was associated with higher odds of having a woman first author, pointing to the importance of mentorship for women joining the transplant academia.

Gender disparities among publications within international sexual medicine urology journals and the impact of blinding in the review process

BACKGROUND

While female urologists are known to publish at less frequency than their male peers, The Journal of Sexual Medicine was reported to have among the highest growth in female authorship from 2002 to 2020 in urology journals.

AIM

We sought to assess the frequency of female authorship in sexual medicine journals worldwide and the factors that affect this, including the blinded/unblinded review process.

METHODS

Eleven sexual medicine journals were assessed for geographic location, peer review method, and SCImago Journal Rank citation index (a metric of citation frequency and prestige). Journals were grouped into top, middle, and bottom quartiles based on metric score. Web of Science was used to access the publications' first, second, last, and corresponding authors from the past 5 years. An internet search or Gender-API.com was used to determine the gender identities of authors. Univariate and multivariable logistic regression models were performed.

OUTCOMES

Outcomes included the likelihood of female authorship (first, second, last, and corresponding) based on journal location and ranking, the clustering of female authors, the journal's peer review process, and the frequency of female editorial board members.

RESULTS

Overall, 8938 publications were identified. Women represented 30.7%, 31.3%, 21.3%, and 18.7% of the first, second, last, and corresponding authors, respectively; gender was unable to be assessed for 2.6%, 17.2%, 7.3%, and 2.7%. On univariate analysis, journals from North America, in the top quartile, and with a double-blind review process were more likely to have female authors (P < .001). On multivariate analysis, articles were more likely to have a female first author if they had a double-blind peer review process (odds ratio [OR], 1.20; 95% CI, 1.02-1.40), a female second author (OR, 2.54; 95% CI, 2.26-2.85), or a female corresponding author (OR, 7.80; 95% CI, 6.69-9.10).

CLINICAL IMPLICATIONS

Gender-concordant mentoring and universal double-blind manuscript review processes may minimize the impact of gender bias and increase female authorship rates, in turn producing more diverse research.

STRENGTHS AND LIMITATIONS

This is the first study assessing female authorship in sexual medicine journals. Limitations include not assessing every author listed on articles and being unable to determine gender identities for some authors.

CONCLUSION

Female authorship rates are higher than reported rates of practicing female urologists but still lower than their male peers. Female authors were more likely to be published in journals with double-blind peer review processes and when publishing with additional female authors.

Making mentoring more impactful for URiM students

Mentorship has been proven to be a valuable vehicle to fight the disparity of diverse representation in medicine. Given the numerous findings that a more diverse medical profession leads to better patient outcomes, we believe fostering mentorship of URiM medical students is in the best interest for patients and the field of medicine. In our manuscript, we illustrated tenets of mentorship that result in effective mentoring of URiM students by any physician regardless of race, ethnicity, or background. This piece reflects upon our personal experiences with structured mentorship programs, results of similar programs at other universities, and ties in a broader conversation of the value of institutional support of mentorship programs. Given the urgency to increase diversity and, ultimately, belonging in not only medical education but also our physician workforce, this piece is highly relevant. This piece is intended to inspire and increase more opportunities for more incoming URiM students to be mentored at the start of their medical journey.

Making an Impact with E.M.P.A.C.T. Engage, Mentor Prepare, Advocate, Cultivate, and Teach: An Innovative Pilot Mentoring Program Evaluation for Students Underrepresented in Medicine

Purpose

Medicine has yet to increase the representation of historically excluded persons in medicine to reflect the general population. The lack of support and guidance in the medical training of these individuals is a significant contributor to this disparity. The Engage, Mentor, Prepare, Advocate for, Cultivate, and Teach (EMPACT) Mentoring program was created to address this problem by providing support for learners who are historically underrepresented in medicine (URiM) as they progress through medical school.

Methods

The EMPACT Pilot Program was formed and conducted during the 2019-2020 academic year. A total of 19 EMPACT mentorship groups were created, each consisting of two mentors and four medical student mentees. Additionally, four professional development workshops were held along with a final Wrap-up and Awards event. Pre and post pilot program surveys along with surveys after each workshop and focus groups were conducted with a random selection of program participants.

Results

When compared to data from before and after the implementation of the EMPACT program, there were statistically significant differences (p < 0.05) in EMPACT mentees reporting they agree or strongly agree they felt ready to handle their clinical rotations (28% to 65%), felt the need to have an advocate (85% to 47%), possessed insight on day-to-day activities of an attending (26% to 56%) and felt a sense of community (79% to 94%). Mentors revealed an increase in their awareness of the concepts of microaggressions and imposter phenomenon. Finally, both groups felt an increase in their support system and sense of community at the school of medicine.

Conclusion

Despite COVID-19 limitations, the EMPACT program met its goals. We effectively supported URiM medical students through mentorship, networking, and community.

A Virtual National Diversity Mentoring Initiative to Promote Inclusion in Emergency Medicine

INTRODUCTION

Trainees underrepresented in medicine (URiM) face additional challenges seeking community in predominantly white academic spaces, as they juggle the effects of institutional, interpersonal, and internalized racism while undergoing medical training. To offer support and a space to share these unique experiences, mentorship for URiM trainees is essential. However, URiM trainees have limited access to mentorship from URiM faculty. To address this gap, we developed a national virtual mentoring program that paired URiM trainees interested in emergency medicine (EM) with experienced mentors.

METHODS

We describe the implementation of a virtual Diversity Mentoring Initiative (DMI) geared toward supporting URiM trainees interested in EM. The program development involved 1) partnering of national EM organizations to obtain funding; (2) identifying a comprehensive platform to facilitate participant communication, artificial intelligence-enabled matching, and ongoing data collection; 3) focusing on targeted recruitment of URiM trainees; and (4) fostering regular leadership meeting cadence to customize the platform and optimize the mentorship experience.

CONCLUSION

We found that by using a virtual platform, the DMI enhanced the efficiency of mentor-mentee pairing, tailored matches based on participants' interests and the bandwidth of mentors, and successfully established cross-institutional connections to support the mentorship needs of URiM trainees.

[Mentorship in electrophysiology : What does it take? What's the advantage?]

Mentoring has long been a fundamental part of medical education. In this article, the term mentoring is defined and the requirements, advantages, and methods of structuring are discussed. Further, the use of mentoring in the context of education in electrophysiology will be highlighted. In this setting, requirements on the personal level of mentors and mentees as well as on the institutional level are outlined, and different phases and types of mentoring are discussed.

Diversity in the Dermatology Workforce and in Academic Medicine

Health disparities exist in marginalized patient populations throughout medical specialties, including in dermatology. It is important that the physician workforce reflect the diversity of the US population to address these disparities. At present, the dermatology workforce does not reflect the racial or ethnic diversity of the US population. The subspecialties of pediatric dermatology, dermatopathology, and dermatologic surgery are even less diverse than the dermatology workforce as a whole. Although women make up over half of the population of dermatologists, disparities still exists in areas such as compensation and presence in leadership positions.

Evaluating the Role of Mentorship in Career Advancement: A Survey of Women in Academic Hand Surgery

PURPOSE

Despite the increasing percentage of women within the American Society for Surgery of the Hand, women remain underrepresented within leadership in academic hand surgery. Although this disparity in leadership representation may be improving, we aimed to investigate the role mentorship plays in advancing women in academic hand surgery.

METHODS

This is a survey-based, mixed-methods study. A written survey assessing themes in personal and professional experiences with mentorship was sent to hand fellowship-trained women. Inclusion criteria were the completion of a hand fellowship and current affiliation with an academic institution. An evolved grounded theory framework was used to evaluate the responses. Themes were identified based on common responses.

RESULTS

Of 186 eligible participants, 144 (85.2%) received the survey. The response rate was 48.6%. Respondents indicated that residency was the stage at which mentorship was most impactful (n = 25, 37%), and half of the respondents identified their desire to work in academic hand surgery during residency (n = 35, 50%). Obstacles to finding a mentor included lack of availability (n = 46, 67.7%), hesitance in searching for a mentor (n = 16, 23.5%), and searching for a mentor within an environment that was not conducive to success for trainees (n = 7, 10.3%). Most (84%) cited instances were the ones having the advice of a woman mentor was more impactful than that of a mentor who is a man. The reported need for same-sex mentorship fell into three categories: (1) insight into shared experiences, (2) assistance with conflict/bias management, and (3) support during career navigation.

CONCLUSIONS

The findings of this study demonstrate the need for high-quality mentorship during the residency with a specific emphasis on same-sex mentorship.

CLINICAL RELEVANCE

Our findings provide clear objectives related to improving access to and quality of mentorship. This foundational understanding will enrich mentor-mentee relationships, allowing for greater personal and professional success and satisfaction for both parties.

Racial Diversity and Black Vascular Surgeons in Vascular Surgery Workforce

OBJECTIVES

The precise number of actively practicing vascular surgeons who self-identify as Black and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data has been collected and maintained at the societal or national board level. Vascular Surgery Societal reports suggest that less than 2% of vascular surgeons identify as Black. Blacks make up 13.4% of the American population yet for disorders such as peripheral arterial disease and end stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age adjusted basis. Significant body of research showed that clinical outcomes like medication adherence, shared decision making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black vascular surgeons.

METHODS

A cross sectional survey was conducted via a questionnaire sent to all participants of a Society of Black Vascular Surgeons (SBVS) that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics and professional society engagement.

RESULTS

Fifty-nine percent of the SBVS members completed the survey. Males compromised 81% of the responding vascular surgeons. The majority (62%) of respondents are involved in academic practice. Less than 25% percent of the total medical staff was Black in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%) and American Indian and Alaskan Natives (0.4%). Forty three percent of respondents have a current active membership in the Society of Vascular Surgery and 24% have regional society membership. Fifty-eight percent of respondents reported that they experienced workplace event that they felt were racially or ethically driven in the 12 months prior to the survey.

CONCLUSION

This survey describes an underrepresented in medicine (URM) vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty, and to develop benchmark goals of race composition that mirrors our society at large. In this group of Black vascular surgeons, their patients were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.

All of Residency's a Stage: Fostering Authenticity and Individuality Among Learners

Understanding the process of professional identity formation, and its susceptibility to the hidden curriculum, is of increasing importance in medical education. Through a lens of performance, this commentary explores the impact of the culture, the hidden curriculum, and the socialization process of the medical training environment on the professional identity formation of learners. We emphasize the need to train physicians with diverse interests and skills, capable of creative problem solving in response to the rapidly evolving challenges facing the profession and society more broadly. Opportunities for learners to drive cultural change and promote authenticity and unique professional identity formation are identified.

Someone Like Me: An Examination of the Importance of Race-Concordant Mentorship in Urology

OBJECTIVE

To describe differences in urology mentorship exposure for medical students across race/ethnicity and to explore how much potential mentees valued the importance of race-concordant mentorship.

METHODS

All medical students at UCLA received a cross-sectional survey. Dependent variables were perceived quality of mentorship in urology and association between race-concordant mentorship and perceived importance of race-concordant mentorship. Mentors were self-selected by medical students. Variables were compared across race/ethnicity using descriptive statistics and multivariate analyses. Subset analyses looking at race-concordance between mentor and student was performed using stratified Cochran-Mantel-Haenszel tests. This was performed to determine if there were differences, across race/ethnicity, in rating of importance of having a race-concordant mentor.

RESULTS

The likelihood of having a urologist as a mentor was similar across race/ethnicity. Under-Represented in Medicine (URiM) students were more likely to report that having a mentor of the same race/ethnicity was extremely important (Asian 9%, Black 58%, Latinx 55% and White 3%, P < .001) compared to their non-URiM peers who were more likely to rate having a race-concordant mentor as not at all important (Asian 34%, Black 5%, Latinx 8%, White 79%, P < .001). URiM students with race-concordant mentors were still more likely to rate having a mentor of the same race/ethnicity as extremely/very important (73%) compared to their non-URiM peers (9%, P = .001). URiM students with race-discordant mentors also rated importance of mentors of the same race/ethnicity as extremely/very important (67%) compared to their non-URiM peers (11%, P = .006).

CONCLUSION

URiM medical students regard race-concordant mentorship as extremely important. Interventions addressing mentor racial/ethnic concordance and those promoting culturally responsive mentorship may optimize recruitment of URiM students into urology.

Inclusion and representation in the pediatric surgery workforce: Strategies to mitigate bias in the fellowship application process

Diverse perspectives are critical components of effective teams in every industry. Underrepresentation of minorities in medicine leads to worse outcomes for minority patients, and efforts to increase diversity in the health care workforce are critical. Presently, about 70% of the pediatric surgery workforce is white, and pediatric surgeons at large do not reflect the racial or ethnic diversity of the populations they serve. Pediatric surgery fellowship training programs are the gateway to the field, and fellow selection processes should be optimized to support diversity and inclusion. The Association of Pediatric Surgery Training Program Directors (APSTPD) Diversity Equity and Inclusion subcommittee compiled best practices for bias mitigation during fellow selection, drawing from published literature and personal experiences in our own programs. A list of concrete recommendations was compiled, which can be implemented in every phase from applicant screening to rank list creation. We present these as a position statement that has been endorsed by the executive committee of the APSTPD. Pediatric surgery fellowship programs can utilize this focused review of best practices to mitigate bias and support diverse applicants.

For us by us: Instituting mentorship models that credit minoritized medical faculty expertise and lived experience

The woefully low proportion of scientists and clinicians underrepresented in medicine (UIM), including members of African-American/Black, Hispanic/Latinx, American Indian/Alaska Native or Native Hawaiian/Pacific Islander communities, is well characterized and documented. Diversity in medicine is not only just, but it improves quality and outcomes. Yet, diversity in academic medicine remains stagnant, despite national recognition and urgent calls to improve diversity, equity, and inclusion across health sciences. One strategy that has shown to improve diversity in many sectors is high quality mentoring. While many institutions have adopted mentoring programs, there remains a lack of mentorship that is equitable, individualized, and sets a clear timeline for academic milestones that will position UIM mentees at the optimal trajectory for promotion and retention. A barrier to assembling these programs is the small number of UIM among the senior faculty ranks who are able to serve in this role, given the disproportionate burden to serve on a multitude of academic committees, task forces, and workgroups to fulfill institutional mandates to diversify representation. These time-consuming services, documented in the literature as the "minority tax," are generally uncompensated and unaccounted for in terms of consideration for promotion, leadership positions, and other measures of career advancement. The Justice, Equity, Diversity, and Inclusion Academic Mentors (JAM) Council represents a novel, culturally responsive, and anti-racist approach to achieve a more equitable and inclusive institutional environment. This approach strategically leverages the intergenerational wisdom and experience of senior UIM faculty via time-protected effort with the overall goals of improving rates of promotion, retention, and career satisfaction of early career UIM colleagues. This community case study describes the rationale, resources needed, processes, and proposed workflow required to launch the JAM Council, as well as the major roles and responsibilities for JAM mentors and mentees, which may be considered by academic medical centers focused on improving diversity among the faculty ranks.

Diversity-related Factors in Research Mentorship and Publishing in the ACBS Community and the Journal of Contextual Behavioral Science

Gender, racial, and ethnic disparities persist in the scientific community despite increasing attention to research-related equity. Men publish in biomedical, scientific journals more frequently than women researchers and have more leadership roles (e.g., first authorship) in these submissions. Similar differences in scientific publishing appear among under-represented minority (URM) authors compared to White counterparts. These findings of authorship disparities are not consistent across all journals and may relate to mentorship variables. This study aimed to investigate gender and racial patterns of publishing and research mentorship within the Association for Contextual Behavioral Science (ACBS) community, including in the Journal of Contextual Behavioral Science (JCBS). Two hundred and eighty-two ACT for Professionals listserv members responded to the anonymous 31-item survey. Men reported significantly more publications and more first author manuscripts than women, both in scientific journals generally and in JCBS specifically. White versus URM respondents more frequently reported publishing in JCBS, but not in other scientific journals. There were no differences in the total number of barriers noted between men and women or between White respondents and URM respondents. The top barriers to publishing among all respondents were lack of time, institutional support, and funding. Women more frequently reported lack of adequate research mentorship or collaboration as a barrier to publishing in scientific journals, as well as in JCBS specifically; men more frequently reported experiencing publishing barriers related to embargos and not having research that was appropriate for JCBS. Identifying as the same gender as one's primary research mentor did not relate to any areas of training. However, participants whose race differed from their mentor were significantly more likely to report training in running a study and receiving positive encouragement. Being matched in terms of gender or race with one's mentor did not relate to publishing variables. Findings highlight the continued gender and racial disparities in publishing within the ACBS community and in JCBS. Recommendations for decreasing these differences through research mentorship and structured training efforts are provided.

What Do Medical Students Want From a Mentor?

Introduction

The medical education literature lacks a uniform definition of mentoring. Mentoring relationships benefit the mentor and mentee. Mentoring roles include coach, advisor, teacher, counselor, and sponsor in the setting of mutual trust toward impacting psychosocial and career functions for the mentee. Mentoring helps improve underrepresented minority medical student performance. Medical students value mentoring relationships. Student mentees note a positive influence on career planning and research and saw mentors as counselors, idea providers, and role models. Medical students' varied goals and development call for personalized, flexible mentoring.

Methods

This study sought to expand the current understanding of medical student mentoring. We emailed a voluntary Qualtrics survey to second-, third-, and fourth-year medical students at the Florida International University (FIU) Herbert Wertheim College of Medicine asking, "What do you want from a mentor (choose all that apply)?" Multiple choice options were constructed based upon literature search. We conducted one-way analysis of variance and Tukey's test to identify whether mentoring preferences differed by student academic year.

Results

Of 363 students, 171 responded (47% response rate). Top-rated responses included honest feedback, responsiveness, and professional connections or networking opportunities.

Discussion

Student desire for honest feedback from mentors was prioritized, affirming the lack of need for impression management in the mentoring relationship. This investigation will be useful for specific mentoring relationships, helping to trigger discussion regarding specific mentoring hopes and training mentors.

The Nature and Evolution of the Mentoring Relationship in Academic Health Centers

Mentoring has a long tradition in academic health centers, and from an institutional perspective can positively impact retention, wellness, promotion success, work satisfaction, and more. On the individual level, mentorship can provide professional growth and personal satisfaction for both participants. However, mentors may struggle with how to build their mentorship skills, navigating challenges with mentees over time, or if/how/when to conclude a mentor-mentee relationship. Mentees may not understand how to find a mentor, what the nature of that relationship is, or what their role is (what characterizes a "good" mentee). As important as mentorship is, it can be challenging for both to find and maintain a high-quality mentor-mentee relationship. This article reviews the qualities that are most critical in developing a successful mentoring relationship, the longitudinal nature of this relationship, common problems that arise, and the potential rewards that exist for each person involved in the relationship.

Characterization of National Medical Societies' Accessible Resources to Support Underrepresented Minority and Female Trainees

IMPORTANCE

The lack of racial, ethnic, and gender diversity in medicine has been recognized as problematic, but the question of what medical educators and societies are doing to rectify and promote representation of historically marginalized groups persists.

OBJECTIVE

To examine what easily accessible resources are offered by medical and surgical societies to support women and individuals in minority groups that are underrepresented in medicine (URiM).

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study evaluated transparent and accessible resources on the webpages of societies recognized by the Council of Medical Specialty Societies. Data collection and analysis were performed from September 1, 2021, to November 1, 2021.

MAIN OUTCOMES AND MEASURES

The society websites were searched for official diversity statements, diversity and women task forces or committees, and mentorship and scholarship opportunities for URiM and female trainees. The primary outcome was accessible resources in the form of financial support (scholarships) and mentorship for URiM and female trainees.

RESULTS

Of the 45 societies included in the analysis, 38 (84.4%) have published diversity statements. All but 6 societies (86.7%) have a dedicated diversity task force, committee, or work group. Twenty societies (44.4%) have a committee specifically for women or include women in diversity task force initiatives. Seventeen societies (37.8%) offer minority-specific mentorship, 15 (33.3%) offer scholarships targeted toward URiM trainees, 10 (22.2%) provide gender-specific mentorship, and 8 (17.8%) offer scholarship opportunities for female trainees.

CONCLUSIONS AND RELEVANCE

Although most of the societies included in this study acknowledge the importance of diversity in medicine, less than half of these societies offer readily accessible scholarships or mentorship opportunities to URiM and female applicants.

Redefining the Gender Gap in Urology Authorship: An 18-Year Publication Analysis

BACKGROUND

Academic authorship is a critical productivity metric used for academic promotion.

OBJECTIVE

To characterize temporal changes in female representation in academic authorship in ten primary urology journals as the complement of female urologists is increasing.

DESIGN, SETTING, AND PARTICIPANTS

Publication records were retrieved from 2002 to 2020 for the ten urology journals with the highest impact factor. The names of all authors were gathered and gender was inferred using first names.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Trends in first and last/senior authorship by gender were evaluated overall, within journals, and by geographic region.

RESULTS

A total of 59,375 articles were analyzed, of which 94.1% had gender information for the first author and 94.2% had gender information for the last author. The percentage of overall female authors increased positively from 17.2% (95% highest density interval [HDI] 12.9-21.4%) in 2002 to 27.2% (HDI 21.7-33.6%; p < 0.01) in 2020. Overall female first authorship increased from 15.2% (95% HDI 11.0-19.5%) to 28.5% (95% HDI 21.8-35.6%; p < 0.01). There was also significant growth for female senior authors from 10.4% (95% HDI 7.6-13.5%) to 18.6% (95% HDI 13.6-23.8%; p < 0.01). Assessment of journal-specific changes revealed that Neurourology and Urodynamics (12.6%, 95% HDI 9.9-15.1%) and The Journal of Sexual Medicine (16.2%, 95% HDI 13.6-19.0%) had significantly higher growth in female authorship when compared to Journal of Endourology (7.2%, 95% HDI 5.5-8.7%) and Urologic Oncology (4.5%, 95% HDI 2.0-6.8%; p < 0.05).

CONCLUSIONS

Although overall female authorship increased between 2002 and 2020, women remain underrepresented in urology authorship. The percentage of females in senior (last) author positions is less than the percentage of females in first author positions. Journal-specific differences can probably be attributed to gender-based differences in subspecialized fields.

PATIENT SUMMARY

In this study, we characterized the underrepresentation of women as authors in urology journals and analyzed the change in female authorship for ten academic urology journals over the course of 18 years. Although the proportion of female authors has increased over that time, the percentage of females in senior authorship roles is less than the percentage of females in first author positions.

It Takes a Village: A Narrative Review of Anesthesiology Mentorship

Mentorships play a critical role in the development of physician careers and should be tailored within a structured, evidence-based mentoring program to ensure mutual benefit and avoidance of pitfalls. We offer a narrative review of the current literature and commentary on mentoring at the medical student, GME trainee, and early career faculty levels within anesthesiology, and propose a framework on which an effective mentoring program can be implemented.

Glass Ceiling in Hand Surgery: Publication Trends by Gender

BACKGROUND

Women are frequently underrepresented across surgical subspecialties and may face barriers to academic advancement. Abstracts presented at American Society for Surgery of the Hand annual meeting (ASSH-AM) highlight some of the top research in hand surgery. We sought to explore differences in abstract characteristics and publication rates based on senior author gender.Though there have been increasing efforts at inclusivity in orthopedic and plastic surgery, women face several barriers to entering the field, publish less frequently, and are underrepresented in leadership positions. Understanding the stages at which discrepancies in research productivity exist may help to address these challenges.

METHODS

Abstracts from the 2010-2017 ASSH-AMs were reviewed to determine basic characteristics. Author gender was determined through both a search of institutional websites for gender-specific pronouns and inference of gender based on first name. Subsequent full manuscript publications corresponding to the abstracts were identified through a systematic search of PubMed and Google Scholar.

RESULTS

A total of 560/620 (90.3%) abstracts from 2010-2017 had an identifiable senior author gender (14.5% female). No differences were noted between male- and female-authored abstracts regarding study design including sample size or level of evidence. Female senior authors were more likely than males to author abstracts focused on pediatrics (19.8% vs 9.4%, p=0.01) and were more likely to collaborate with female first authors (41.3% vs 20.0%, p<0.01). Abstract publication rates were lower for female senior authors versus male senior authors (61.7% vs 74.5%, p=0.02).

CONCLUSION

The number of abstracts with female senior authors had similar representation to the membership proportion of women in the ASSH. There were few differences in abstract characteristics based on senior author gender, though senior authors tend to collaborate with investigators of the same gender. Abstracts authored by females were published 13% less frequently overall, meriting further exploration. Level of Evidence: III.

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action

The global COVID-19 pandemic has brought to light the significant inequities in the delivery of healthcare, vaccine inequity, and differential access to life-saving treatments, which have disproportionately impacted marginalized and racialized populations. In this article, we acknowledge and recognize the centuries-old legacies perpetuating inequity, injustice, and oppression, we discuss the principles of Equity, Diversity, and Inclusion (EDI) and we call our Canadian plastic surgery colleagues and trainees to action. We propose a plan for (1) Education, (2) Mitigating Disparities in the Clinical Setting, and (3) Policy, Societies, and Leadership Education.

Responding to Recommended Changes to the 2020-2021 Residency Recruitment Process From a Diversity, Equity, and Inclusion Perspective

In May 2020, the Coalition for Physician Accountability's Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training (WG) released its final report and recommendations. These recommendations pertain to away rotations, virtual interviews, Electronic Residency Application Service opening for programs and the overall residency timeline, and general communications and attempt to provide clarity and level the playing field during the 2020-2021 residency application cycle. The WG's aims include promoting professional accountability by improving the quality, efficiency, and continuity of the education, training, and assessment of physicians. The authors argue the first 3 WG recommendations may disproportionately impact candidates from historically excluded and underrepresented groups in medicine (HEURGMs) and may affect an institution's ability to ensure equity in the selection of residency applicants and, thus, warrant further consideration. The authors examine these recommendations from a diversity, equity, and inclusion (DEI) perspective. For each of the first 3 WG recommendations, the authors highlight new opportunities created by the recommendations and detail challenges that programs must carefully navigate to ensure equity for all candidates. The authors also recommend solutions to guide programs as they address these challenges, meet new common program requirements, and attempt to promote equity for HEURGMs. Finally, the authors recommend that after the 2020-2021 recruitment cycle, the medical education community evaluate DEI-related outcomes of both the WG's and the authors' recommendations and incorporate the findings into future application cycles.

Diversity, Equity, and Inclusion Among Anesthesiology Trainees

Background:

Historically in medicine, women and minorities have been underrepresented. This trend is especially significant in the anesthesiology workforce.

Objective:

The goals of this study were to quantify the current state of diversity by race/ethnicity, gender, and sexual orientation among anesthesiology residents.

Methods:

An institutionally reviewed and validated survey was delivered through Qualtrics to 130 anesthesiology program directors. Topics addressed included gender identity, sexual orientation, racial and ethnic background, rationale for pursuing anesthesiology, and medical training experiences. The study was administered from February to April 2021; 135 anesthesiology residents responded to the survey.

Results:

The sample was 44.4% white (n = 60), 54.1% male (n = 73), and 83.7% (n = 113) of respondents self-reported as straight or heterosexual. Respondents indicated that role models/mentors were somewhat or very important in their desire to pursue anesthesiology (n = 85; 67.2%), 42% reported that having women/diverse faculty was somewhat or very important in their decision to pursue anesthesiology. Discrimination during the anesthesiology residency application process or as a resident ranged from 4.4% due to sexual orientation to 18.7% due to gender/gender identity and race/ethnicity.

Conclusions:

Experiences of discrimination based on race/ethnicity, gender, and gender identity continues to be a concern among anesthesiology trainees. Creating an environment that is inclusive and supportive of all trainees regardless of race/ethnicity, gender/gender identity, and sexual orientation is needed. Interventions and strategies to create an inclusive environment may improve diversity within anesthesiology.

Diversifying the dermatology workforce: Physician characteristics vary by race/ethnicity

BACKGROUND

In the United States (US), dermatology remains one of the least diverse specialties in medicine. Increasing the diversity of the dermatology workforce is essential for reducing health disparities.

OBJECTIVE

To describe the experiences of racially and ethnically diverse physicians in the US who successfully matched into dermatology.

METHODS

Board-certified dermatologists and dermatology residents were recruited to participate in an anonymous, online survey in which self-reported demographic, socioeconomic, pre-residency, and post-residency career data were obtained.

RESULTS

Of the 100 participants included in the study, 30% were dermatology residents and 25% belonged to a group underrepresented in medicine (UIM). Black physicians were 3.69 times more likely to select dermatology prior to medical school (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.04 - 13.0) compared to non-Black physicians. UIM dermatologists and trainees were more likely to receive a need-based scholarship in medical school (OR, 4.37; 95% CI, 1.30 - 14.7), graduate from a private medical institution (OR, 6.49; 95% CI, 1.95 - 21.6), and have at least one UIM dermatology mentor during medical school (adjusted OR, 13.1; 95% CI, 2.77 - 61.5) compared to non-UIM physicians.

CONCLUSIONS

A holistic review of dermatology applicants by residency programs may reduce racial/ethnic disparities in the admission process. Our data provide further evidence in support of pre-medical outreach programs, mentorship, and institutional funding to promote diversity in dermatology.

Update: Diversity and Practice Patterns of International Craniomaxillofacial Surgeons

BACKGROUND

The authors' group characterized the cranio-maxillo-facial workforce 10 years ago, revealing high levels of career satisfaction but significant gender disparity. This study provides an updated profile of the international cranio-maxillo-facial workforce.

METHODS

A 30-question electronic survey was distributed to 387 cranio-maxillo-facial surgeons with membership in the American Society of Craniofacial Surgeons, American Society of Maxillofacial Surgeons, and International Society of Craniofacial Surgery. Questions related to demographics, training background, practice setting, surgical volume, career satisfaction, and perceived discrimination. Independent samples t test was used to compare continuous variables.

RESULTS

The authors received 91 responses (response rate = 23.5%). The majority of respondents were White (n = 73, 80.2%), non-Hispanic (n = 85, 93.4%), heterosexual (n = 72, 79.1%), cisgender males (n = 74, 81.3%). Practice setting was primarily academic, 65.9% (n = 60) and group/hospital-based 88.3% (n = 68), with two-thirds of respondents practicing in the United States. Female surgeons reported earlier planned retirement (66 versus 70 years, P = 0.012) and more personal encounters with discrimination of any kind (69% versus 29%, P = 0.033). US craniofacial surgeons reported more racial and sexual orientation-based discrimination compared with non-US surgeons (P = 0.049 and P = 0.048, respectively). Older surgeons (>55 years old) reported less perceived gender discrimination (P = 0.041). There was no difference between subgroups in career satisfaction or likelihood of repeating/recommending a cranio-maxillo-facial fellowship.

CONCLUSIONS

Female representation in cranio-maxillo-facial surgery on an international scale has increased over the past decade, but this study demonstrates persistent, disparate perception of workplace discrimination by gender, practice region, and age.

Insights Gained into the Use of Individual Development Plans as a Framework for Mentoring NIH Postbaccalaureate Research Education Program (PREP) Trainees

This study examines the use of individual development plans (IDPs) in a structured mentoring program as an effective mechanism for reducing identity-related anxiety for underrepresented trainees and increasing their learner agency. Social cognitive theory served to provide the theoretical framework for our implementation of IDPs and our investigation of the effects of completing IDPs on trainees attaining academic goals and subsequent success in enrolling in competitive PhD programs. Results suggest that IDPs are also an effective tool that can allow faculty mentors to provide the social support necessary for trainees to persist in accomplishing their short- and long-term learning goals. Additionally, trainee self-agency, in the use of the IDP and mentoring, seemed to provide an alternative narrative to ability as a sole predictor of STEM achievement. We also found that IDPs helped foster social support networks, providing stability, predictability, and a sense of belonging. Specifically, IDPs helped foster the emotional and informational support necessary for trainees to persist, despite obstacles, as they strived to attain their learning goals.

Representation of American Indian and Alaska Native Individuals in Academic Medical Training

IMPORTANCE

Identifying gaps in inclusivity of Indigenous individuals is key to diversifying academic medical programs, increasing American Indian and Alaska Native representation, and improving disparate morbidity and mortality outcomes in American Indian and Alaska Native populations.

OBJECTIVE

To examine representation of American Indian and Alaska Native individuals at different stages in the 2018-2019 academic medical training continuum and trends (2011-2020) of American Indian and Alaska Native representation in residency specialties.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional, population-based analysis was conducted using self-reported race and ethnicity data on trainees from the Association of American Medical Colleges (2018), the Accreditation Council for Graduate Medical Education (2011-2018), and the US Census (2018). Data were analyzed between February 18, 2020, and March 4, 2021.

EXPOSURES

Enrolled trainees at specific stages of medical training.

MAIN OUTCOMES AND MEASURES

The primary outcome was the odds of representation of American Indian and Alaska Native individuals at successive academic medical stages in 2018-2019 compared with White individuals. Secondary outcomes comprised specialty-specific proportions of American Indian and Alaska Native residents from 2011 to 2020 and medical specialty-specific proportions of American Indian and Alaska Native physicians in 2018. Fisher exact tests were performed to calculate the odds of American Indian and Alaska Native representation at successive stages of medical training. Simple linear regressions were performed to assess trends across residency specialties.

RESULTS

The study data contained a total of 238 974 607 White and American Indian and Alaska Native US citizens, 24 795 US medical school applicants, 11 242 US medical school acceptees, 10 822 US medical school matriculants, 10 917 US medical school graduates, 59 635 residents, 518 874 active physicians, and 113 168 US medical school faculty. American Indian and Alaska Native individuals had a 63% lower odds of applying to medical school (odds ratio [OR], 0.37; 95% CI, 0.31-0.45) and 48% lower odds of holding a full-time faculty position (OR, 0.52; 95% CI, 0.44-0.62) compared with their White counterparts, yet had 54% higher odds of working in a residency specialty deemed as a priority by the Indian Health Service (OR, 1.54; 95% CI, 1.09-2.16). Of the 33 physician specialties analyzed, family medicine (0.55%) and pain medicine (0.46%) had more than an average proportion (0.41%) of American Indian and Alaska Native physicians compared with their representation across all specialties.

CONCLUSIONS AND RELEVANCE

This cross-sectional study noted 2 distinct stages in medical training with significantly lower representation of American Indian and Alaska Native compared with White individuals. An actionable framework to guide academic medical institutions on their Indigenous diversification and inclusivity efforts is proposed.

Outcomes From a Novel Graduate Medical Education Leadership Program in Advancing Diversity, Equity, and Inclusion

BACKGROUND

Academic medicine needs more diverse leadership from racial/ethnic minorities, women, people with disabilities, and LGBTQIA+ physicians. Longitudinal structural support programs that bring together underrepresented in medicine (UiM) and non-UiM trainees are one approach to build leadership and scholarship capacity in diversity, equity, and inclusion (DEI).

OBJECTIVE

To describe the creation, satisfaction with, and feasibility of a Leadership Education in Advancing Diversity (LEAD) Program and evaluate scholars' changes in self-efficacy, intended and actual behavior change, and outputs in leadership and DEI scholarship.

METHODS

In 2017, we created the LEAD Program, a 10-month longitudinal, single institution program that provides residents and fellows ("scholars") across graduate medical education (GME) with leadership training and mentorship in creating DEI-focused scholarship. In the first 3 cohorts (2017-2020), we assessed scholars' self-efficacy, actual and planned behavior change, and program satisfaction using IRB-approved, de-identified retrospective pre-/post-surveys. We measured scholarship as the number of workshops presented and publications developed by the LEAD scholars. We used descriptive statistics and paired 2-tailed t tests to analyze the data.

RESULTS

Seventy-five trainees completed LEAD; 99% (74 of 75) completed the retrospective pre-/post-surveys. There was statistically significant improvement in scholars' self-efficacy for all learning objectives. All trainees thought LEAD should continue. LEAD scholars have created workshops and presented at local, regional, and national conferences, as well published their findings. Scholars identified the greatest benefits as mentorship, developing friendships with UiM and ally peers outside of their subspecialty, and confidence in public speaking.

CONCLUSIONS

LEAD is an innovative, feasible GME-wide model to improve resident and fellow self-efficacy and behaviors in DEI scholarship and leadership.