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Nguyen M, Mason HRC, Russell R, Fancher T, Chaudhry SI, Desai MM, Boatright D. Leave of Absence and Medical Student Placement Into Graduate Medical Education by Race and Ethnicity. JAMA 2024:2817549. [PMID: 38619837 PMCID: PMC11019442 DOI: 10.1001/jama.2024.4797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/07/2024] [Indexed: 04/16/2024]
Abstract
This study examines the association between taking a leave of absence from medical school and placement into graduate medical education (GME) by race and ethnicity.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Regina Russell
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Tonya Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine, Sacramento
| | | | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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2
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Ryus CR, Yang D, Brackett A, Barnett L, Boatright D. Examining trends in emergency medicine journals' publications about racism. Acad Emerg Med 2024; 31:339-345. [PMID: 38097532 DOI: 10.1111/acem.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE In recent years, the academic medicine community has produced numerous statements and calls to action condemning racism. Though health equity work examining health disparities has expanded, few studies specifically name racism as an operational construct. As emergency departments serve a high proportion of patients with social and economic disadvantage rooted in structural racism, it is critically important that racism be a focus of our academic discourse. This study examines the frequency at which four prominent emergency medicine journals, Annals of Emergency Medicine, Academic Emergency Medicine, the American Journal of Emergency Medicine, and the Western Journal of Emergency Medicine, publish on health disparities and racism. METHODS This is a descriptive analysis measuring the frequency of publications on health disparities and racism in U.S.-based emergency medicine journals from 2014 to 2021. The search strategies for the concepts of "racism" and "health disparities" used a combination of MeSH and keywords. These search strategies were developed based on prior literature and the MEDLINE/PubMed Health Disparities and Minority Health Search Strategy. Articles identified through the PubMed search were then reviewed by two authors for final inclusion. RESULTS Since 2014, a total of 6248 articles were published by the four emergency medicine journals over the 8-year study period. Of those, 82 research papers that focused on health disparities were identified and only 16 that focused on racism. Most emergency medicine publications on racism and health disparities were in 2021. CONCLUSIONS Our findings suggest that the national discourse on racism and calls to action within emergency medicine were followed by an increase in publications on health disparities and racism. Continued investigation is needed to evaluate these trends moving forward.
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Affiliation(s)
- Caitlin R Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Yang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandria Brackett
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lindsay Barnett
- Yale University Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, New York University, New York, New York, USA
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Nguyen M, Cavazos JE, Venkataraman S, Fancher TL, Chaudhry SI, Desai MM, Boatright D. Socioeconomic Diversity in Admissions to MD-PhD Programs, 2014-2019. JAMA Netw Open 2024; 7:e241951. [PMID: 38470423 PMCID: PMC10936114 DOI: 10.1001/jamanetworkopen.2024.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/21/2024] [Indexed: 03/13/2024] Open
Abstract
This cohort study of applicants to US MD-PhD programs examines the association of application outcomes with family income.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Jose E. Cavazos
- South Texas MSTP, University of Texas Health San Antonio, San Antonio
| | - Shruthi Venkataraman
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Tonya L. Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine, Sacramento
| | | | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Boatright D, Nguyen M, Hill K, Berg D, Castillo-Page L, Anderson N, Agbelese V, Venkataraman S, Saha S, Schoenbaum SC, Richards R, Jordan A, Asabor E, White MA. Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools. JAMA Netw Open 2024; 7:e240001. [PMID: 38381434 PMCID: PMC10882418 DOI: 10.1001/jamanetworkopen.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/26/2023] [Indexed: 02/22/2024] Open
Abstract
Importance Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students' perception of the climate of equity and inclusion are limited. Objective To develop and validate an instrument to measure students' perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). Design, Setting, and Participants The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education-accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. Exposures Student race and ethnicity, sex, sexual orientation, and socioeconomic status. Main Outcomes and Measures Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. Results Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students' perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). Conclusions and Relevance This study found that the new tool is a reliable and psychometrically valid measure of medical students' perceptions of equity and inclusion in the learning environment.
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Affiliation(s)
- Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | | | - David Berg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Victoria Agbelese
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Shruthi Venkataraman
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Somnath Saha
- Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Regina Richards
- Office of Diversity, Equity, Inclusion and Community Engagement, University of Colorado Anschutz Medical Campus, Aurora
| | - Ayana Jordan
- Department of Psychiatry, New York University Grossman School of Medicine
| | - Emmanuella Asabor
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Marney A. White
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Havemann C, Mason HRC, Russell RG, Casillas A, Nguyen M, Boatright D, Webber A, Parrilla JA, Gallegos A, Wyatt TR. Challenges Facing First-Generation College Graduates in Medical School: A Qualitative Analysis. JAMA Netw Open 2023; 6:e2347528. [PMID: 38091039 PMCID: PMC10719755 DOI: 10.1001/jamanetworkopen.2023.47528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023] Open
Abstract
Importance First-generation (FG) medical students remain underrepresented in medicine despite ongoing national efforts to increase diversity; understanding the challenges faced by this student population is essential to building holistic policies, practices, and learning environments that promote professional actualization. Although FG students have been extensively studied in the undergraduate literature, there is little research investigating how FG students experience medical education or opportunities for educators to intervene. Objective To explore challenges that FG students experience in undergraduate medical education and identify opportunities to improve foundational FG support. Design, Setting, and Participants This qualitative study was conducted using an online platform with 37 FG students enrolled in 27 US medical schools. An interprofessional team of medical educators and trainees conducted semistructured interviews from November 2021 through April 2022. Participants were recruited using a medical student listserv. Data were analyzed from April to November 2022. Main Outcomes and Measures After conducting a preliminary analysis using open coding, a codebook was created and used in a thematic analysis; the codebook used a combination of deductive and inductive coding. Results Among the 37 students recruited for this study, 21 (56.8%) were female; 23 (62.2%) were in the clinical phase of training; 1 (2.7%) was American Indian or Alaska Native, 7 (18.9%) were Hispanic, Latino, or of Spanish origin, 8 (21.6%) were non-Hispanic Asian or Asian American, 9 (24.3%) were non-Hispanic Black or African American, and 23 (32.4%) were non-Hispanic White; mean (SD) age was 27.3 (2.8) years. Participants described 4 major themes: (1) isolation and exclusion related to being a newcomer to medicine; (2) difficulty with access to basic resources (eg, food, rent, transportation) as well as educational (eg, books); (3) overall lack of faculty or institutional support to address these challenges; and (4) a sense of needing to rely on grit and resilience to survive. Conclusions and Relevance Although grit and resilience are desirable traits, results of this study suggest that FG medical students face increased adversity with inadequate institutional support, which forces them to excessively rely on grit and resilience as survival (rather than educational) strategies. By applying the holistic model often used in admissions to the postmatriculation educational process, targeted and flexible initiatives can be created for FG students so that all students, regardless of background, can achieve robust professional actualization.
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Affiliation(s)
| | | | | | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
| | | | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, Emergency Medicine and Population Health, NYU Grossman School of Medicine, New York, New York
| | - Alexis Webber
- Department of General Surgery, Albany Medical Center, Albany, New York
| | | | - Abraham Gallegos
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California
| | - Tasha R. Wyatt
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland
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Sanchez S, Westervelt M, Boatright D, Fancher T, London M, Concepcion AJ, Manriquez JAN, McDade W, Gonzalo JD. Promising Practices in US Sponsoring Institutions to Advance Diversity, Equity, and Inclusion in Graduate Medical Education. J Grad Med Educ 2023; 15:638-647. [PMID: 38045934 PMCID: PMC10686655 DOI: 10.4300/jgme-d-23-00260.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/16/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023] Open
Abstract
Background Best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood. The Accreditation Council for Graduate Medical Education launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion award for sponsoring institutions to celebrate efforts to improve DEI in graduate medical education (GME). Objective To identify themes in practices used by award applicants to improve DEI efforts at their institutions, using a qualitative design. Methods This qualitative study employed an exploratory, inductive approach and constant comparative method to analyze award applications from 2 submission cycles (2020, 2021). Data analysis involved the use of a preliminary codebook of 29 program applications used in a previous study, which was modified and expanded, to perform a subsequent analysis of 12 sponsoring institution applications. Seven adjudication sessions were conducted to ensure coding consistency and resolve disagreements, resulting in the identification of final themes. Results Institutions' approaches to advancing DEI resulted from work within 5 themes and 10 subthemes. The themes encompassed organizational commitment (policies that reflect DEI mission), data infrastructure (tracking recruitment, retention, and inclusion efforts), community connection (service-learning opportunities), diverse team engagement (coproduction with residents), and systematic strategies for DEI support throughout the educational continuum. Consistent across themes was the importance of collaboration, avoiding silos, and the need for a comprehensive longitudinal approach to DEI to achieve a diverse GME workforce. Conclusions This qualitative study identified 5 themes that can inform and guide sponsoring institutions in promoting DEI.
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Affiliation(s)
- Stephany Sanchez
- Stephany Sanchez, MD, is Associate Professor and Associate Program Director, Department of Internal Medicine, University of California, Davis, California, USA
| | - Marjorie Westervelt
- Marjorie Westervelt, PhD, MPH, is Director of Assessment, Evaluation, and Scholarship, University of California, Davis School of Medicine, Davis, California, USA
| | - Dowin Boatright
- Dowin Boatright, MD, MBA, MHS, is Associate Professor, Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Tonya Fancher
- Tonya Fancher, MD, MPH, is Professor and Vice Chair for Workforce Diversity, Department of Internal Medicine, University of California, Davis, California, USA
| | - Maya London
- Maya London, BS, is a Medical Student, University of California, Davis School of Medicine, Davis, California, USA
| | - Arra Jane Concepcion
- Arra Jane Concepcion, BA, is Manager, Center for a Diverse Healthcare Workforce, University of California, Davis School of Medicine, Davis, California, USA
| | - Jose A. Negrete Manriquez
- Jose A. Negrete Manriquez, MD, MPP, is a Resident Physician, Department of Internal Medicine, University of California, Davis, California, USA
| | - William McDade
- William McDade, MD, PhD, is Chief Diversity, Equity, and Inclusion Officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA; and
| | - Jed D. Gonzalo
- Jed D. Gonzalo, MD, MSc, is Professor of Medicine and Health Systems and Implementation Science, and Senior Associate Dean for Medical Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Hennein R, Tiako MJN, Bonumwezi J, Tineo P, Boatright D, Crusto C, Lowe SR. Vicarious Racism, Direct Racism, and Mental Health Among Racialized Minority Healthcare Workers. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01844-7. [PMID: 37935947 DOI: 10.1007/s40615-023-01844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Racism-related stress is a root cause of racial and ethnic disparities in mental health outcomes. An individual may be exposed to racism directly or vicariously by hearing about or observing people of the same racial and/or ethnic group experience racism. Although the healthcare setting is a venue by which healthcare workers experience both direct and vicarious racism, few studies have assessed the associations between direct and vicarious racism and mental health outcomes among healthcare workers. METHODS In this cross-sectional study, we assessed the relationships between direct and vicarious racism and symptoms of posttraumatic stress, depression, and anxiety among healthcare workers in the USA in 2022. RESULTS Our sample consisted of 259 healthcare workers identifying as a racialized minority, including 68 (26.3%) who identified as mixed-race, 61 (23.6%) East Asian, 36 (13.9%) Black, 33 (12.7%) South Asian, 22 (8.5%) Southeast Asian, 21 (8.1%) Middle Eastern/North African, and 18 (6.9%) another race. The mean age was 37.9 years (SD 10.1). In multivariable linear regression models that adjusted for demographics, work stressors, and social stressors, we found that increased reporting of vicarious racism was associated with greater symptoms of anxiety (B = 0.066, standard error = 0.034, p = .049). We did not identify significant relationships between vicarious and direct racism and symptoms of posttraumatic stress or depression in the fully adjusted models. CONCLUSIONS Our findings should be considered by academic health systems to mitigate the negative impact of racism on healthcare workers' mental health.
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Affiliation(s)
- Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, USA.
- Yale School of Medicine, New Haven, CT, USA.
| | | | - Jessica Bonumwezi
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Petty Tineo
- Department of Psychology, Montclair State University, Montclair, NJ, USA
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Cindy Crusto
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Nguyen M, Fancher TL, Boatright D. Temporal Trends in Childhood Household Income Among Medical School Applicants and Matriculants-Reply. JAMA 2023; 330:1288-1289. [PMID: 37787797 DOI: 10.1001/jama.2023.14930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Mytien Nguyen
- School of Medicine, Yale University, New Haven, Connecticut
| | - Tonya L Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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Lett E, Tran NK, Nweke N, Nguyen M, Kim JG, Holmboe E, McDade W, Boatright D. Intersectional Disparities in Emergency Medicine Residents' Performance Assessments by Race, Ethnicity, and Sex. JAMA Netw Open 2023; 6:e2330847. [PMID: 37733347 PMCID: PMC10514741 DOI: 10.1001/jamanetworkopen.2023.30847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/19/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments. Objective To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments. Design, Setting, and Participants This retrospective cohort study used data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education Milestones (Milestones) assessments to evaluate ratings for EM residents at 128 EM training programs in the US. Statistical analyses were conducted in June 2020 to January 2023. Exposure Training and assessment environments in EM residency programs across comparison groups defined by ethnoracial identity (Asian, White, or groups underrepresented in medicine [URM], ie, African American/Black, American Indian/Alaska Native, Hispanic/Latine, and Native Hawaiian/Other Pacific Islander) and sex (female/male). Main Outcomes and Measures Mean Milestone scores (scale, 0-9) across 6 core competency domains: interpersonal and communications skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and system-based practice. Overall assessment scores were calculated as the mean of the 6 competency scores. Results The study sample comprised 128 ACGME-accredited programs and 16 634 assessments for 2708 EM residents of which 1913 (70.6%) were in 3-year and 795 (29.4%) in 4-year programs. Most of the residents were White (n = 2012; 74.3%), followed by Asian (n = 477; 17.6%), Hispanic or Latine (n = 213; 7.9%), African American or Black (n = 160; 5.9%), American Indian or Alaska Native (n = 24; 0.9%), and Native Hawaiian or Other Pacific Islander (n = 4; 0.1%). Approximately 14.3% (n = 386) and 34.6% (n = 936) were of URM groups and female, respectively. Compared with White male residents, URM female residents in 3-year programs were rated increasingly lower in the medical knowledge (URM female score, -0.47; 95% CI, -0.77 to -0.17), patient care (-0.18; 95% CI, -0.35 to -0.01), and practice-based learning and improvement (-0.37; 95% CI, -0.65 to -0.09) domains by postgraduate year 3 year-end assessment; URM female residents in 4-year programs were also rated lower in all 6 competencies over the assessment period. Conclusions and Relevance This retrospective cohort study found that URM female residents were consistently rated lower than White male residents on Milestone assessments, findings that may reflect intersectional discrimination in physician competency evaluation. Eliminating sex-specific ethnoracial disparities in resident assessments may contribute to equitable health care by removing barriers to retention and promotion of underrepresented and minoritized trainees and facilitating diversity and representation among the emergency physician workforce.
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Affiliation(s)
- Elle Lett
- Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nguyen Khai Tran
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, California
| | - Nkemjika Nweke
- St George’s University School of Medicine, St George, Grenada
| | | | - Jung G. Kim
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Dowin Boatright
- Ronald O. Perelman Department of Emergency Medicine, New York University, New York
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Yang DH, Justen M, Lee D, Kim H, Boatright D, Desai M, Tiyyagura G. Experiences with Racism Among Asian American Medical Students. JAMA Netw Open 2023; 6:e2333067. [PMID: 37695582 PMCID: PMC10495868 DOI: 10.1001/jamanetworkopen.2023.33067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students. Objective To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment. Design, Setting, and Participants This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years. Main Outcomes and Measures The medical school experiences of Asian American medical students. Results Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future. Conclusions and Relevance In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.
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Affiliation(s)
- David H. Yang
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Marissa Justen
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Dana Lee
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Heeryoung Kim
- Department of Psychiatry, Middlesex Hospital, Middletown, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University School of Medicine, New York
| | - Miraj Desai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gunjan Tiyyagura
- Department of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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12
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Wyatt TR, Casillas A, Webber A, Parrilla JA, Boatright D, Mason H. The maintenance of classism in medical education: "time" as a form of social capital in first-generation and low-income medical students. Adv Health Sci Educ Theory Pract 2023:10.1007/s10459-023-10270-7. [PMID: 37526802 DOI: 10.1007/s10459-023-10270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
As first generation (FG)/low income (LI) students enter the elite profession of medicine, schools make presumptions about how FGLI students allocate their time. However, their lives are markedly different compared to their peers. This study argues that while all forms of capital are necessary for success, time as a specific form keeps classism in place. Using constructivist grounded theory techniques, we interviewed 48 FGLI students to understand where, why and how they allocated their time, and the perceived impact it had on them. Using open coding and constant comparison, we developed an understanding of FGLI students' relationship to time and then contextualized it within larger conversations on how time is conceptualized in a capitalist system that demands time efficiency, and the activities where time is needed in medical school. When students discussed time, they invoked the concept of 'time famine;' having too much to do and not enough time. In attempting to meet medicine's expectations, they conceptualized time as something that was 'spent' or 'given/taken' as they traversed different marketplaces, using their time as a form of currency to make up for the social capital expected of them. This study shows that because medical education was designed around the social elite, a strata of individuals who have generational resources, time is a critical aspect separating FGLI students from their peers. This study undergirds the idea that time is a hidden organizational framework that helps to maintain classism, thus positioning FGLI students at a disadvantage.
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Affiliation(s)
- T R Wyatt
- Center for Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD20814, USA.
| | - A Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - A Webber
- Tufts Medical Center School, Boston, USA
| | - J A Parrilla
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, USA
| | - D Boatright
- Ronald O. Perelman Department of Emergency Medicine, Emergency Medicine and Population Health, NYU Grossman School of Medicine, New York, USA
| | - H Mason
- Tufts University School of Medicine, Boston, MA, USA
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13
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Boatright D, Edje L, Gruppen LD, Hauer KE, Humphrey HJ, Marcotte K. Ensuring Fairness in Medical Education Assessment. Acad Med 2023; 98:S1-S2. [PMID: 37073970 DOI: 10.1097/acm.0000000000005244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Dowin Boatright
- D. Boatright is vice chair of research, Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Louito Edje
- L. Edje is associate dean of graduate medical education, designated institutional official, and professor of medical education and family and community medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Larry D Gruppen
- L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards, and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Holly J Humphrey
- H.J. Humphrey is president, Josiah Macy Jr. Foundation, New York, New York
| | - Kayla Marcotte
- K. Marcotte is an MD-PhD student, University of Michigan Medical School, Ann Arbor, Michigan
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14
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Anderson N, Nguyen M, Marcotte K, Ramos M, Gruppen LD, Boatright D. The Long Shadow: A Historical Perspective on Racism in Medical Education. Acad Med 2023; 98:S28-S36. [PMID: 37071703 PMCID: PMC10584990 DOI: 10.1097/acm.0000000000005253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
To dismantle racism in U.S. medical education, people must understand how the history of Christian Europe, Enlightenment-era racial science, colonization, slavery, and racism shaped modern American medicine. Beginning with the coalescence of Christian European identity and empire, the authors trace European racial reasoning through the racial science of the Enlightenment into the White supremacist and anti-Black ideology behind Europe's global system of racialized colonization and enslavement. The authors then follow this racist ideology as it becomes an organizing principle of Euro-American medicine and examine how it manifests in medical education in the United States today. Within this historical context, the authors expose the histories of violence underlying contemporary terms such as implicit bias and microaggressions. Through this history, they also gain a deeper appreciation of why racism is so prevalent in medical education and how it affects admissions, assessments, faculty and trainee diversity, retention, racial climate, and the physical environment. The authors then recommend 6 historically informed steps for confronting racism in medical education: (1) incorporate the history of racism into medical education and unmask institutional histories of racism, (2) create centralized reporting mechanisms and implement systematic reviews of bias in educational and clinical activities, (3) adopt mastery-based assessment in medical education, (4) embrace holistic review and expand its possibilities in admissions, (5) increase faculty diversity by using holistic review principles in hiring and promotions, and (6) leverage accreditation to combat bias in medical education. These strategies will help academic medicine begin to acknowledge the harms propagated throughout the history of racism in medicine and start taking meaningful steps to address them. Although the authors have focused on racism in this paper, they recognize there are many forms of bias that impact medical education and intersect with racism, each with its particular history, that deserve their own telling and redress.
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Affiliation(s)
- Nientara Anderson
- N. Anderson is a resident, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mytien Nguyen
- M. Nguyen is an MD-PhD student, Yale School of Medicine, New Haven, Connecticut
| | - Kayla Marcotte
- K. Marcotte is an MD-PhD student, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marco Ramos
- M. Ramos is assistant professor, Section of History of Science and Medicine and Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Larry D Gruppen
- L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Dowin Boatright
- D. Boatright is vice chair of research, Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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15
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Nguyen M, Lett E, Cavazos JE, Chaudhry SI, Desai MM, Jeffe DB, Boatright D. Association of Racial and Ethnic Identity With Attrition From MD-PhD Training Programs. JAMA Intern Med 2023; 183:2807946. [PMID: 37523174 PMCID: PMC10391356 DOI: 10.1001/jamainternmed.2023.2822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/20/2023] [Indexed: 08/01/2023]
Abstract
This cohort study analyzes the attrition rates of students from MD-PhD training programs by race and ethnicity.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Applied Transgender Studies, Chicago, Illinois
| | - Jose E. Cavazos
- South Texas Medical Science Training Program, University of Texas Health San Antonio, San Antonio, Texas
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Donna B. Jeffe
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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16
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Nguyen M, Gonzalez L, Newman A, Cannon A, Zarebski SA, Chaudhry SI, Pomahac B, Boatright D, Dardik A. Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020. JAMA Surg 2023; 158:756-764. [PMID: 37195709 PMCID: PMC10193263 DOI: 10.1001/jamasurg.2023.1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/17/2023] [Indexed: 05/18/2023]
Abstract
Importance Surgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists. Objective To examine how NIH funding has been awarded to surgeon-scientists over time. Design, Setting, and Participants This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022. Main Outcome National Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties. Results Between 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P < .001). However, substantial disparity remained, with female surgeon-scientists receiving less than 20% of NIH grants and funding dollars in 2020. In addition, although there was increased NIH funding to neurosurgeons and otolaryngologists, funding to urologists decreased significantly from 14.9% of all grants in 1995 to 7.5% in 2020 (annual percent change, -0.39% [95% CI, -0.47% to -0.30%]; P < .001). Despite surgical diseases making up 30% of the global disease burden, representation of surgeon-scientists among NIH investigators remains less than 2%. Conclusion and Relevance This study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Luis Gonzalez
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Ashley Newman
- Howard University School of Medicine, Washington, DC
| | - Ashley Cannon
- Technical Resources International, Bethesda, Maryland
| | | | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Department of Surgery, Veterans Affairs Connecticut Healthcare System, West Haven
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17
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Nguyen M, Panyadahundi A, Olagun-Samuel C, Chaudhry SI, Desai MM, Dardik A, Boatright D. Transition From Mentored to Independent NIH Funding by Gender and Department. JAMA 2023; 329:2189-2190. [PMID: 37367985 PMCID: PMC10300699 DOI: 10.1001/jama.2023.7693] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 06/28/2023]
Abstract
This study uses National Institutes of Health RePORTER data for mentored K awards and R01-equivalent grants to all departments in US schools of medicine to characterize K-award distribution and K-to-R transition by gender and department between 1997 and 2021.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Aanya Panyadahundi
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Sarwat I. Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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18
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Nguyen M, Desai MM, Fancher TL, Chaudhry SI, Mason HRC, Boatright D. Temporal Trends in Childhood Household Income Among Applicants and Matriculants to Medical School and the Likelihood of Acceptance by Income, 2014-2019. JAMA 2023; 329:1882-1884. [PMID: 37166785 PMCID: PMC10176183 DOI: 10.1001/jama.2023.5654] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/22/2023] [Indexed: 05/12/2023]
Abstract
This study examines trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut
| | - Tonya L. Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine, Sacramento
| | - Sarwat I. Chaudhry
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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19
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Solnick RE, Jarou ZJ, Zogg CK, Boatright D. Political Priorities, Voting, and Political Action Committee Engagement of Emergency Medicine Trainees: A National Survey. West J Emerg Med 2023; 24:469-478. [PMID: 37278793 PMCID: PMC10284518 DOI: 10.5811/westjem.59351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Medicine is increasingly influenced by politics, but physicians have historically had lower voter turnout than the general public. Turnout is even lower for younger voters. Little is known about the political interests, voting activity, or political action committee (PAC) involvement of emergency physicians in training. We evaluated EM trainees' political priorities, use of and barriers to voting, and engagement with an emergency medicine (EM) PAC. METHODS Resident/medical student Emergency Medicine Residents' Association members were emailed a survey between October-November 2018. Questions involved political priorities, perspective on single-payer healthcare, voting knowledge/behavior, and EM PACs participation. We analyzed data using descriptive statistics. RESULTS Survey participants included 1,241 fully responding medical students and residents, with a calculated response rate of 20%. The top three healthcare priorities were as follows: 1) high cost of healthcare/price transparency; 2) decreasing the number of uninsured; and 3) quality of health insurance. The top EM-specific issue was ED crowding and boarding. Most trainees (70%) were supportive of single-payer healthcare: "somewhat favor" (36%) and "strongly favor" (34%). Trainees had high rates of voting in presidential elections (89%) but less frequent use of other voting options: 54% absentee ballots; 56% voting in state primary races; and 38% early voting. Over half (66%) missed voting in prior elections, with work cited as the most frequent (70%) barrier. While overall, half of respondents (62%) reported awareness of EM PACs, only 4% of respondents had contributed. CONCLUSION The high cost of healthcare was the top concern among EM trainees. Survey respondents had a high level of knowledge of absentee and early voting but less frequently used these options. Encouragement of early and absentee voting can improve voter turnout of EM trainees. Concerning EM PACs, there is significant room for membership growth. With improved knowledge of the political priorities of EM trainees, physician organizations and PACs can better engage future physicians.
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Affiliation(s)
- Rachel E. Solnick
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York (Current)
- Yale School of Medicine, Department of Emergency Medicine, New Haven Connecticut (Previously at)
| | | | | | - Dowin Boatright
- NYU Grossman School of Medicine, Department of Emergency Medicine, New York
- Yale School of Medicine, Department of Emergency Medicine, New Haven Connecticut (Previously at)
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Ayedun A, Agbelese V, Curry L, Gotian R, Castillo-Page L, White M, Antwi AD, Buchanan M, Girma M, Kline D, Okeke C, Raghu A, Saleh H, Schwartz A, Boatright D. Perspectives on National Institutes of Health Funding Requirements for Racial and Ethnic Diversity Among Medical Scientist Training Program Leadership. JAMA Netw Open 2023; 6:e2310795. [PMID: 37126348 PMCID: PMC10152303 DOI: 10.1001/jamanetworkopen.2023.10795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Importance Since 1964, the National Institutes of Health (NIH) has funded the Medical Scientist Training Program (MSTP) MD-PhD program at medical schools across the US to support training physician-scientists. Recent studies have suggested that MSTPs have consistently matriculated more students from racial and ethnic backgrounds historically underrepresented in science than MD-PhD programs without NIH funding; however, the underlying basis for the increased diversity seen in NIH-funded MSTPs is poorly understood. Objective To investigate how administrators and faculty perceive the impact of MSTP status on MD-PhD program matriculant racial and ethnic diversity. Design, Setting, and Participants This qualitative study used a positive deviance approach to identify 9 high-performing and 3 low-performing MSTPs based on the percentage of students underrepresented in science who matriculated into the program between 2014 and 2018. This study, a subanalysis of a larger study to understand recruitment of students underrepresented in science at MSTPs, focused on in-depth qualitative interviews, conducted from October 26, 2020, to August 31, 2022, of 69 members of MSTP leadership, including program directors, associate and assistant program directors, and program administrators. Main Outcomes and Measures The association of NIH funding with institutional priorities, programs, and practices related to MD-PhD program matriculant racial and ethnic diversity. Results The study included 69 participants (mean [SD] age, 53 [10] years; 38 women [55%]; 13 African American or Black participants [19%], 6 Asian participants [9%], 12 Hispanic participants [17%], and 36 non-Hispanic White participants [52%]). A total of 51 participants (74%) were in administrative roles, and 18 (26%) were faculty involved in recruitment. Five themes emerged from the data: (1) by tying MSTP funding to diversity efforts, the NIH created a sense of urgency among MSTP leadership to bolster matriculant diversity; (2) MD-PhD program leadership leveraged the changes to MSTP grant review to secure new institutional investments to promote recruitment of students underrepresented in science; (3) MSTPs increasingly adopted holistic review to evaluate applicants to meet NIH funding requirements; (4) MSTP leadership began to systematically assess the effectiveness of their diversity initiatives and proactively identify opportunities to enhance matriculant diversity; and (5) although all MSTPs were required to respond to NIH criteria, changes made by low-performing programs generally lacked the robustness demonstrated by high-performing programs. Conclusions and Relevance This study suggests that NIH funding requirements may be a powerful incentive to promote diversity and positively affect representation of students underrepresented in science in the biomedical scientific workforce.
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Affiliation(s)
- Adeola Ayedun
- Global Health Leadership Initiative, Yale School of Public Health, New Haven, Connecticut
| | - Victoria Agbelese
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Leslie Curry
- Department of Health Policy and Management, Yale School of Management, New Haven, Connecticut
| | - Ruth Gotian
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Laura Castillo-Page
- The National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | - Marney White
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | | | | | - Meron Girma
- Yale School of Public Health, New Haven, Connecticut
| | | | | | - Akshaya Raghu
- Yale School of Public Health, New Haven, Connecticut
| | - Hamza Saleh
- Yale School of Public Health, New Haven, Connecticut
| | - Anna Schwartz
- Yale School of Public Health, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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21
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Hill KA, Desai MM, Chaudhry SI, Fancher T, Nguyen M, Wang K, Boatright D. National Institutes of Health Diversity Supplement Awards by Medical School. J Gen Intern Med 2023; 38:1175-1179. [PMID: 36344641 PMCID: PMC10110783 DOI: 10.1007/s11606-022-07849-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Increasing medical school faculty diversity is an urgent priority. National Institutes of Health (NIH) diversity supplements, which provide funding and career development opportunities to individuals underrepresented in research, are an important mechanism to increase faculty diversity. OBJECTIVE Analyze diversity supplement utilization by medical schools. DESIGN Retrospective cohort study. PARTICIPANTS All R01 grant-associated diversity supplements awarded to medical schools from 2005 to 2020. Diversity supplements were identified using the publicly available NIH RePORTER database. MAIN MEASURES Main measures were the number of R01-associated diversity supplements awarded to medical schools each year by medical school NIH funding status and the number of R01-associated diversity supplements awarded to individual medical schools in the NIH top 40 by funding status. We also examined the percentage of R01 grants with an associated diversity supplement by NIH funding status and individual medical school in the NIH top 40. KEY RESULTS From 2005 to 2020, US medical school faculty received 1389 R01-associated diversity supplements. The number of diversity supplements awarded grew from 2012 to 2020, from ten to 187 for top 40 schools, and from seven to 83 for non-top 40 schools. The annual growth rate for diversity supplement awards at NIH top 40 schools (44.2%) was not significantly different than the annual growth rate among non-top 40 schools (36.2%; p = 0.68). From 2005 to 2020, the highest number of diversity supplements that an individual medical school received was 56 and the lowest number was four (mean = 24.6, SD = 11.7). The highest percentage of R01 grants with an associated diversity supplement received by a school was 4.5% and the lowest percentage was 0.79% (mean = 2.3%, SD = 0.98). CONCLUSION Medical schools may be missing an opportunity to address the continuing shortage of individuals historically underrepresented in biomedical science and should consider additional mechanisms to enhance diversity supplement utilization.
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Affiliation(s)
- Katherine A Hill
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology and Office of Diversity, Equity, Inclusion, and Belonging, Yale School of Public Health, New Haven, CT, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine and Office of Student Research, Yale School of Medicine, New Haven, CT, USA
| | - Tonya Fancher
- Department of Internal Medicine and Office of Workforce Innovation and Community Engagement, University of California, Davis, Davis, CA, USA
| | - Mytien Nguyen
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Karen Wang
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
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22
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Overbeek DL, Janke AT, Watson CJ, Salhi RA, Kim E, Boatright D, Losman ED. Disparate Utilization of Urine Drug Screen Nationwide in the Evaluation of Acute Chest Pain. West J Emerg Med 2023; 24:135-140. [PMID: 36976604 PMCID: PMC10047743 DOI: 10.5811/westjem.2022.11.58231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/16/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Urine drug screens (UDS) have unproven clinical utility in emergency department (ED) chest pain presentations. A test with such limited clinical utility may exponentiate biases in care, but little is known about the epidemiology of UDS use for this indication. We hypothesized that UDS utilization varies nationally across race and gender. METHODS This was a retrospective observational analysis of adult ED visits for chest pain in the 2011-2019 National Hospital Ambulatory Medical Care Survey. We calculated the utilization of UDS across race/ethnicity and gender and then characterized predictors of use via adjusted logistic regression models. RESULTS We analyzed 13,567 adult chest pain visits, representative of 85.8 million visits nationally. Use of UDS occurred for 4.6% of visits (95% CI 3.9%-5.4%). White females underwent UDS at 3.3% of visits (95% CI 2.5%-4.2%), and Black females at 4.1% (95% CI 2.9%-5.2%). White males were tested at 5.8% of visits (95% CI 4.4%-7.2%), while Black males were tested at 9.3% of visits (95% CI 6.4%-12.2%). A multivariate logistic regression model including race, gender, and time period shows significantly increased odds of ordering UDS for Black patients (odds ratio [OR] 1.45 (95% CI 1.11-1.90, p = 0.007)) and male patients (OR 2.0 (95% CI 1.55-2.58, p < 0.001) as compared to White patients and female patients. CONCLUSION We identified wide disparities in the utilization of UDS for the evaluation of chest pain. If UDS were used at the rate observed for White women, Black men would undergo nearly 50,000 fewer tests annually. Future research should weigh the potential of the UDS to magnify biases in care against the unproven clinical utility of the test.
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Affiliation(s)
- Daniel L Overbeek
- University of Rochester School of Medicine and Dentistry, Department of Emergency Medicine, Rochester, New York
| | - Alexander T Janke
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
- Institute for Healthcare Policy and Innovation, VA Ann Arbor/University of Michigan, Ann Arbor, Michigan
| | - C James Watson
- Boston Children's Hospital, Harvard Medical Toxicology Program, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Rama A Salhi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Erin Kim
- Institute for Healthcare Policy and Innovation, VA Ann Arbor/University of Michigan, Ann Arbor, Michigan
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Eve D Losman
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan University of Michigan Medical School, Ann Arbor, Michigan
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Nguyen M, Gonzalez L, Chaudhry SI, Ahuja N, Pomahac B, Newman A, Cannon A, Zarebski SA, Dardik A, Boatright D. Gender Disparity in National Institutes of Health Funding Among Surgeon-Scientists From 1995 to 2020. JAMA Netw Open 2023; 6:e233630. [PMID: 36939702 PMCID: PMC10028489 DOI: 10.1001/jamanetworkopen.2023.3630] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/30/2023] [Indexed: 03/21/2023] Open
Abstract
Importance Surgical diseases account for approximately 30% of the global burden of disease. Gender diversity in biomedical research is critical to generate innovative patient-centered research in surgery. Objective To examine the distribution of biomedical research funding by the National Institutes of Health (NIH) among women and men surgeon-scientists during a 25-year period. Design, Setting, and Participants This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) database for research project grants awarded to women and men surgeon-scientists who were principal investigators between 1995 and 2020. Data were retrieved between January 20 and March 20, 2022. The representation of women surgeon-scientists among academic surgeons was compared with the representation of men surgeon-scientists over time. Main Outcomes and Measures Distribution of NIH funding to women and men surgeon-scientists was examined via 2 metrics: holding a large-dollar (ie, R01-equivalent) grant and being a super principal investigator (SPI) with $750 000 or more in total annual research funding. Statistical analysis was performed between April 1 and August 31, 2022. Results Between 1995 and 2020, 2078 principal investigator surgeons received funding from the NIH. The proportion of women academic surgeons who were surgeon-scientists remained unchanged during this same period (1995, 14 of 792 [1.8%] vs 2020, 92 of 3834 [2.4%]; P = .10). Compared with their men counterparts, women surgeon-scientists obtained their first NIH grant earlier in their career (mean [SD] years after first faculty appointment, 8.8 [6.2] vs 10.8 [7.9] years; P < .001) and were as likely to obtain large-dollar grants (aRR, 0.99 [95% CI, 0.95-1.03]) during the period 2016 to 2020. Despite this success, women surgeon-scientists remained significantly underrepresented among SPIs and were 25% less likely to be an SPI (aRR, 0.75 [95% CI, 0.60-0.95] during the period 2016 to 2020). Conclusions and Relevance The findings of this cross-sectional study of NIH-funded surgeons suggest that women surgeons remained underrepresented among surgeon-scientists over a 25-year period despite early career success in receiving NIH funding. This is concerning and warrants further investigation to increase the distribution of NIH funding among women surgeon-scientists.
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Affiliation(s)
| | | | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nita Ahuja
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
- Department of Biological and Biomedical Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Ashley Newman
- Howard University School of Medicine, Washington, DC
| | - Ashley Cannon
- Technical Resources International, Bethesda, Maryland
| | | | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
- Department of Biological and Biomedical Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Surgery, VA Connecticut Healthcare System, West Haven
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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24
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Nguyen M, Chaudhry SI, Desai MM, Dzirasa K, Cavazos JE, Boatright D. Gender, Racial, and Ethnic and Inequities in Receipt of Multiple National Institutes of Health Research Project Grants. JAMA Netw Open 2023; 6:e230855. [PMID: 36853608 PMCID: PMC9975935 DOI: 10.1001/jamanetworkopen.2023.0855] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Diversity in the biomedical research workforce is essential for addressing complex health problems. Female investigators and investigators from underrepresented ethnic and racial groups generate novel, impactful, and innovative research, yet they are significantly underrepresented among National Institutes of Health (NIH) investigators. OBJECTIVE To examine the gender, ethnic, and racial distribution of super NIH investigators who received 3 or more concurrent NIH grants. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included a national cohort of NIH-funded principal investigators (PIs) from the NIH Information for Management, Planning, Analysis, and Coordination (IMPAC II) database from 1991 to 2020. EXPOSURES Self-identified gender, race and ethnicity, annual number of NIH grant receipt, career stage, and highest degree. MAIN OUTCOMES AND MEASURES Distribution of investigators receiving 3 or more research project grants, referred to as super principal investigators (SPIs), by gender, race, and ethnicity. RESULTS Among 33 896 investigators in fiscal year 2020, 7478 (22.01%) identified as Asian, 623 (1.8%) as Black, 1624 (4.8%) as Hispanic, and 22 107 (65.2%) as White; 21 936 (61.7%) identified as men; and 8695 (35.3%) were early-stage investigators. Between 1991 and 2020, the proportion of SPIs increased 3-fold from 704 (3.7%) to 3942 (11.3%). However, SPI status was unequal across gender, ethnic, and racial groups. Women and Black PIs were significantly underrepresented among SPIs, even after adjusting for career stage and degree, and were 34% and 40% less likely than their male and White colleagues, respectively, to be an SPI. Black women PIs were the least likely to be represented among SPIs and were 71% less likely to attain SPI status than White men PIs (adjusted odds ratio, 0.29; 95% CI, 0.21-0.41). CONCLUSIONS AND RELEVANCE In this cross-sectional study of a national cohort of NIH-funded investigators, the gender, ethnic, and racial gaps in receipt of multiple research project grants among NIH investigators was clearly apparent and warrants further investigation and interventions.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Epidemiology of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Kafui Dzirasa
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - Jose E. Cavazos
- South Texas Medical Science Training Program, University of Texas Health San Antonio, San Antonio
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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25
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Boatright D, London M, Soriano AJ, Westervelt M, Sanchez S, Gonzalo JD, McDade W, Fancher TL. Strategies and Best Practices to Improve Diversity, Equity, and Inclusion Among US Graduate Medical Education Programs. JAMA Netw Open 2023; 6:e2255110. [PMID: 36753279 PMCID: PMC9909494 DOI: 10.1001/jamanetworkopen.2022.55110] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
IMPORTANCE Closing the diversity gap is critical to ensure equity in medical education and health care quality. Nevertheless, evidence-based strategies and best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood and underused. To improve the culture of DEI in graduate medical education (GME), in 2020 the Accreditation Council of Graduate Medical Education (ACGME) launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion Award to recognize exceptional DEI efforts in US residency programs. OBJECTIVE To identify strategies and best practices that exemplary US GME programs use to improve DEI. DESIGN AND SETTING This qualitative study performed an exploratory content analysis of award applications submitted to the ACGME over 2 cycles in 2020 and 2021, using the constant comparative method. The research team first acknowledged their own biases related to DEI, used caution to not overinterpret the data, and performed several cross-checks during data analysis to ensure confirmability of the results. A preliminary codebook was developed and used during regular adjudication sessions. Disagreements were discussed until agreements were reached. MAIN OUTCOMES AND MEASURES Foundational (ie, commonly cited, high-impact, and small-effort strategies considered achievable by all programs) and aspirational (ie, potential for high impact but requiring greater effort and investment) DEI strategies used by exemplary GME programs. RESULTS This qualitative study included 29 award applications submitted between August 17, 2020, and January 11, 2022. Strategies spanned the education continuum from premedical students through faculty. Foundational strategies included working with schools, community colleges, and 4-year college campuses; providing structured support for visiting students; mission-driven holistic review for admissions and selection; interviewer trainings on implicit bias mitigation and on how racism and discrimination impact admission processes and advancement; interview-day DEI strategies; inclusive selection and DEI committees; mission statements that include DEI; and retention efforts to improve faculty diversity. Aspirational strategies included development of longitudinal bidirectional collaborations (eg, articulation agreements, annual workshops, funded rotations and/or research) with organizations working with applicants who were historically excluded and underrepresented in medicine, blinding metrics in residency applications, longitudinal curricula on DEI and health equity, and faculty mentoring such as affinity groups, mentored research, and joint academic-community recruitments. Findings provide residency program leadership with a menu of options at various inflection points to foster DEI within their programs. CONCLUSIONS AND RELEVANCE The findings of this qualitative study suggest that GME programs might adopt strategies of exemplary programs to improve DEI in residency, ensure compliance with accreditation standards, and improve health outcomes for all.
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Affiliation(s)
- Dowin Boatright
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
- now with Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Maya London
- currently a medical student at University of California, Davis, School of Medicine
| | - Arra Jane Soriano
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine
| | - Marjorie Westervelt
- Office of Medical Education, University of California, Davis, School of Medicine
| | - Stephany Sanchez
- Department of Internal Medicine, University of California, Davis, School of Medicine
| | - Jed D. Gonzalo
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke
| | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine
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Nguyen M, Fancher T, Boatright D. Attrition of Indigenous Medical Students Requires Swift Institutional Response-Reply. JAMA Intern Med 2022; 182:1330-1331. [PMID: 36315138 DOI: 10.1001/jamainternmed.2022.4936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Tonya Fancher
- Division of General Internal Medicine, University of California Davis School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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27
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Boatright D, Anderson N, Kim JG, Holmboe ES, McDade WA, Fancher T, Gross CP, Chaudhry S, Nguyen M, Nguemeni Tiako MJ, Colson E, Xu Y, Li F, Dziura JD, Saha S. Racial and Ethnic Differences in Internal Medicine Residency Assessments. JAMA Netw Open 2022; 5:e2247649. [PMID: 36580337 PMCID: PMC9857126 DOI: 10.1001/jamanetworkopen.2022.47649] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/03/2022] [Indexed: 12/30/2022] Open
Abstract
Importance Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education. Objective To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents. Design, Setting, and Participants This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022. Main Outcomes and Measures The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes. Results The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P < .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P < .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P < .001). By the final year 3 assessment, the gap between White and Asian and URiM residents' scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training. Conclusions and Relevance In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.
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Affiliation(s)
- Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
| | - Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jung G. Kim
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Eric S. Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - William A. McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya Fancher
- Department of Internal Medicine and Office of Workforce Innovation and Community Engagement, University of California, Davis
| | - Cary P. Gross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat Chaudhry
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | | | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Yunshan Xu
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - James D. Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Somnath Saha
- Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wyatt TR, Nguyen M, Boatright D, R C Mason H. The Creation of Classism in Medical Education: "Time" as a Form of Social Capital in First-Generation Low-Income Students. Acad Med 2022; 97:S182. [PMID: 37838910 DOI: 10.1097/acm.0000000000004835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Tasha R Wyatt
- Author affiliations: T.R. Wyatt, Uniformed Services University; M. Nguyen, D. Boatright, Yale University; H.R.C. Mason, Tufts University School of Medicine
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Nguyen M, Mason HRC, Russell RG, Boatright D. Professional Identity Formation Among Diverse U.S. Medical Students: A Quantitative Analysis of the Impact of Socioeconomic Status. Acad Med 2022; 97:S170. [PMID: 36419759 PMCID: PMC9614546 DOI: 10.1097/acm.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Mytien Nguyen
- Author affiliations: M. Nguyen, D. Boatright, Yale School of Medicine; H.R.C. Mason, Tufts University School of Medicine; R.G. Russell, Vanderbilt School of Medicine
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Nguyen M, Cross J, Chaudhry SI, Cunningham D, Desai MM, Mason HRC, Boatright D. Association of Sex and Ethnoracial Identities with Attrition from Medical School. J Gen Intern Med 2022; 37:3762-3765. [PMID: 35641726 PMCID: PMC9585103 DOI: 10.1007/s11606-022-07458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
| | - Jeremiah Cross
- Department of Emergency Medicine, Highland General Hospital, Oakland, CA, USA
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dervin Cunningham
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Nguemeni Tiako MJ, Rahman F, Sabin J, Black A, Boatright D, Genao I. Piloting web-based structural competency modules among internal medicine residents and graduate students in public health. Front Public Health 2022; 10:901523. [PMID: 36324468 PMCID: PMC9620418 DOI: 10.3389/fpubh.2022.901523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/20/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Fewer than half of internal medicine program directors report any health disparities curriculum. We piloted a web-based healthcare disparities module among internal medicine (IM) residents to test effectiveness and feasibility, compared to a convenient sample of graduate students enrolled in a public health equity course. Methods IM residents participated in an in-person session (module 1: introduction to racial and ethnic health disparities), but first, they completed a pre-module knowledge quiz. Two weeks later, they completed module 2: "unconscious associations" and a post-module knowledge quiz. For the control arm Yale School of Public Health (YSPH) students enrolled in a course on health disparities completed the pre-module knowledge quiz, module 1, and 2 as required by their course instructor. Results Forty-nine IM residents and 22 YSPH students completed the pre-module quiz and Module 1. The mean (SD) score out of 25 possible points for the IM residents on the pre-module quiz was 16.1/25 (2.8), and 16.6/25 (3.2) for YSPH students, with no statistically significant difference. Nineteen residents (38.8%) completed the post-module quiz with a mean score of 16.7/25 (2.2), Hedge's g =0.23, compared to 18 (81.8%) YSPH students, whose mean (SD) score was 19.5/25 (2.1), Hedge's g=1.05. YSPH students' post-module quiz average was statistically significantly higher than their pre-module test score, as well as the residents' post-module test (P < 0.001). In examining participants' responses to specific questions, we found that 51% (n = 25) of residents wrongly defined discrimination with an emphasis on attitudes and intent as opposed to actions and impact, compared to 22.7% (n = 5) YSPH students before the module, vs. 63.2% (n = 12) and 88.9% (n = 16) respectively after. Conclusion After completing a healthcare disparities course, graduate students in public health saw greater gains in knowledge compared to IM residents. Residents' responses showed knowledge gaps such as understanding discrimination, and highlight growth opportunity in terms of health equity education. Furthermore, embedding health equity education in required curricular activities may be a more effective approach.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States,Harvard Medical School, Boston, MA, United States,*Correspondence: Max Jordan Nguemeni Tiako
| | - Farah Rahman
- Loyola Stritch School of Medicine, Chicago, IL, United States
| | - Janice Sabin
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | - Aba Black
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New Haven, CT, United States
| | - Inginia Genao
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States
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Nguyen M, Nguyen ND, Chaudhry SI, Desai MM, Cavazos JE, Boatright D. Inequity in National Institutes of Health Predoctoral Fellowships, 2001-2020. JAMA Netw Open 2022; 5:e2238600. [PMID: 36287568 PMCID: PMC9606849 DOI: 10.1001/jamanetworkopen.2022.38600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines trends in number of awards and funding of general and diversity F31 predoctoral fellowships from 2001 to 2020.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Nghia D. Nguyen
- Program in Neuroscience, Harvard University, Boston, Massachusetts
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health
| | - Jose E. Cavazos
- South Texas MSTP, University of Texas Health San Antonio, San Antonio
| | - Dowin Boatright
- Department of Emergency Medicine, New York Grossman School of Medicine, New York
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Nguyen M, Chaudhry SI, Asabor E, Desai MM, Lett E, Cavazos JE, Mason HRC, Boatright D. Variation in Research Experiences and Publications During Medical School by Sex and Race and Ethnicity. JAMA Netw Open 2022; 5:e2238520. [PMID: 36282497 PMCID: PMC9597391 DOI: 10.1001/jamanetworkopen.2022.38520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Diverse research teams are critical to solving complex health problems and producing high-quality medical research. OBJECTIVE To examine the associations of student sex and racial and ethnic identity with publication rates during medical school. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed individual-level data of US MD graduates from medical school who matriculated in academic years 2014 to 2015 and 2015 to 2016. Data were obtained from the Association of American Medical Colleges and analyzed from October 2021 to January 2022. MAIN OUTCOMES AND MEASURES Outcomes of interest included students' self-reported participation in unique research experiences, number of publications, and computed publications per research experience. Poisson regressions were constructed to determine the association of sex and racial and ethnic identity with research outcomes using adjusted rate ratios (aRRs). RESULTS Among 31 474 graduates, 15 159 (48.2%) identified as women and 4344 (13.8%) identified as underrepresented in medicine by race and ethnicity (URIM; including American Indian, Alaska Native, Black, Hawaiian Native, Hispanic/Latinx, and Pacific Islander individuals). Students who attended National Institutes of Health (NIH) top 40 research-ranked schools reported higher number of research experiences and publication counts, resulting in a higher publication rate compared with students from non-top 40 schools (median [IQR] 1.60 [1.00-3.00] vs 1.25 [0.50-2.33]; P < .001). Women reported a higher number of research experiences than men but a significantly lower number of publications (top 40 schools: aRR, 0.89; 95% CI, 0.87-0.90; non-top 40 schools: aRR, 0.93; 95% CI, 0.92-0.95). This resulted in a significantly lower publication rate among women (top 40 schools: aRR, 0.85; 95% CI, 0.83-0.86; non-top 40 schools: aRR, 0.91; 95% CI, 0.90-0.92). Compared with White students, Asian students had higher publication rates at both NIH top 40 schools (aRR, 1.10; 95% CI, 1.08-1.12) and non-top 40 schools (aRR, 1.07; 95% CI, 1.05-1.08), while lower publication rates were reported among Black students (top 40 schools: aRR, 0.83; 95% CI, 0.80-0.86; non-top 40 schools: aRR, 0.88; 95% CI, 0.85-0.95) and Hispanic students attending non-top 40 schools (aRR, 0.93; 95% CI, 0.90-0.95). CONCLUSIONS AND RELEVANCE These findings illustrate that inequities in the physician-scientist workforce began early in training and highlight key areas for intervention, such as funding support and mentorship training during undergraduate medical education, that may promote the future success of a diverse physician-scientist workforce.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Elle Lett
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jose E. Cavazos
- South Texas Medical Scientist Training Program, University of Texas Health San Antonio, San Antonio
| | | | - Dowin Boatright
- Department of Emergency Medicine, New York Grossman School of Medicine, New York
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Nguyen M, Desai MM, Boatright D. Clarifying Associations of Individual Factors With Medical School Attrition-Reply. JAMA Pediatr 2022; 176:2796977. [PMID: 36190711 DOI: 10.1001/jamapediatrics.2022.3523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology and Office of Diversity, Equity, Inclusion, and Belonging, Yale School of Public Health, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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Hill KA, Desai MM, Chaudhry SI, Nguyen M, McDade W, Xu Y, Li F, Fancher T, Hajduk AM, Westervelt MJ, Boatright D. Association of Marginalized Identities With Alpha Omega Alpha Honor Society and Gold Humanism Honor Society Membership Among Medical Students. JAMA Netw Open 2022; 5:e2229062. [PMID: 36069984 PMCID: PMC9453541 DOI: 10.1001/jamanetworkopen.2022.29062] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Disparities in medical student membership in Alpha Omega Alpha (AOA) are well documented. Less is known about Gold Humanism Honor Society (GHHS) membership and it remains unknown how the intersection of different identities is associated with membership in these honor societies. OBJECTIVE To examine the association between honor society membership and medical student race and ethnicity, sex, sexual orientation, socioeconomic status, and intersection of identities. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from Association of American Medical Colleges data collection instruments. The study included all students who graduated from Liaison Committee on Medical Education-accredited US medical schools from 2016 to 2019 and completed the Graduation Questionnaire. Data analysis was conducted from January 12 to July 12, 2022. MAIN OUTCOMES AND MEASURES Likelihood of AOA and GHHS membership by student race and ethnicity, sex, sexual orientation, childhood family income, and intersection of identities. RESULTS The sample of 50 384 individuals comprised 82 (0.2%) American Indian or Alaska Native, 10 601 (21.0%) Asian, 2464 (4.9%) Black, 3291 (6.5%) Hispanic, 25 (0.1%) Native Hawaiian or Pacific Islander, 30 610 (60.8%) White, 2476 (4.9%) multiracial students, and 834 (1.7%) students of other races or ethnicities. Sex and sexual orientation included 25 672 (51.0%) men and 3078 (6.1%) lesbian, gay, and bisexual (LGB). Childhood family income comprised 31 758 (60.0%) individuals with $75 000 per year or greater, 8160 (16.2%) with $50 000 to $74 999 per year, 6864 (13.6%) with $25 000 to $49 999 per year, and 3612 (7.2%) with less than $25 000 per year. The sample included 7303 (14.5%) AOA members only, 4925 (9.8%) GHHS members only, and 2384 (4.7%) members of both societies. In AOA, American Indian or Alaska Native (OR, 0.49; 95% CI, 0.25-0.96), Asian (OR, 0.49; 95% CI, 0.45-0.53), Black (OR, 0.25; 95% CI, 0.20-0.30), Hispanic (OR, 0.53; 95% CI, 0.47-0.59), multiracial (OR, 0.69; 95% CI, 0.62-0.77), and other race and ethnicity (OR, 0.73; 95% CI, 0.60-0.88) were underrepresented compared with White students; LGB students (OR, 0.75; 95% CI, 0.67-0.83) were underrepresented compared with heterosexual students; and childhood family income $50 000 to $74 999 (OR, 0.81; 95% CI, 0.75-0.86), $25 000 to $49 999 (OR, 0.68; 95% CI, 0.62-0.74), and less than $25 000 (OR, 0.60; 95% CI, 0.53-0.69) were underrepresented compared with greater than or equal to $75 000. In GHHS, Asian students (OR, 0.80; 95% CI, 0.73-0.87) were underrepresented compared with White students, female students (OR, 1.55; 95% CI, 1.45-1.65) were overrepresented compared with male students, LGB students (OR, 1.36; 95% CI, 1.23-1.51) were overrepresented compared with heterosexual students, and students with childhood family income $25 000 to $49 999 (OR, 0.85; 95% CI, 0.78-0.94) and less than $25 000 (OR, 0.75; 95% CI, 0.66-0.86) were underrepresented compared with those with greater than or equal to $75 000. Likelihood of AOA, but not GHHS, membership decreased as number of marginalized identities increased. CONCLUSIONS AND RELEVANCE In this cross-sectional study of US medical students, membership disparities were noted in both AOA and GHHS. However, differences in GHHS existed across fewer identities, sometimes favored the marginalized group, and were not cumulative.
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Affiliation(s)
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Yunshan Xu
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Tonya Fancher
- Department of Internal Medicine and Office of Workforce Innovation and Community Engagement, University of California Davis
| | - Alexandria M. Hajduk
- Training Program in Geriatric Clinical Epidemiology & Aging-Related Research, Yale School of Medicine, New Haven, Connecticut
| | | | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology and Office of Diversity, Equity, Inclusion, and Belonging, Yale School of Public Health, New Haven, Connecticut
| | - Candice Chen
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - William A. McDade
- Accrediation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Abstract
Importance Diversity in the medical workforce is critical to improve health care access and achieve equity for resource-limited communities. Despite increased efforts to recruit diverse medical trainees, there remains a large chasm between the racial and ethnic and socioeconomic composition of the patient population and that of the physician workforce. Objective To analyze student attrition from medical school by sociodemographic identities. Design, Setting, and Participants This retrospective cohort study included allopathic doctor of medicine (MD)-only US medical school matriculants in academic years 2014-2015 and 2015-2016. The analysis was performed from July to September 2021. Main Outcomes and Measures The main outcome was attrition, defined as withdrawal or dismissal from medical school for any reason. Attrition rate was explored across 3 self-reported marginalized identities: underrepresented in medicine (URiM) race and ethnicity, low income, and underresourced neighborhood status. Logistic regression was assessed for each marginalized identity and intersections across the 3 identities. Results Among 33 389 allopathic MD-only medical school matriculants (51.8% male), 938 (2.8%) experienced attrition from medical school within 5 years. Compared with non-Hispanic White students (423 of 18 213 [2.3%]), those without low income (593 of 25 205 [2.3%]), and those who did not grow up in an underresourced neighborhood (661 of 27 487 [2.4%]), students who were URiM (Hispanic [110 of 2096 (5.2%); adjusted odds ratio (aOR), 1.41; 95% CI, 1.13-1.77], non-Hispanic American Indian/Alaska Native/Native Hawaiian/Pacific Islander [13 of 118 (11.0%); aOR, 3.20; 95% CI, 1.76-5.80], and non-Hispanic Black/African American [120 of 2104 (5.7%); aOR, 1.41; 95% CI, 1.13-1.77]), those who had low income (345 of 8184 [4.2%]; aOR, 1.33; 95% CI, 1.15-1.54), and those from an underresourced neighborhood (277 of 5902 [4.6%]; aOR, 1.35; 95% CI, 1.16-1.58) were more likely to experience attrition from medical school. The rate of attrition from medical school was greatest among students with all 3 marginalized identities (ie, URiM, low income, and from an underresourced neighborhood), with an attrition rate 3.7 times higher than that among students who were not URiM, did not have low income, and were not from an underresourced neighborhood (7.3% [79 of 1086] vs 1.9% [397 of 20 353]; P < .001). Conclusions and Relevance This retrospective cohort study demonstrated a significant association of medical student attrition with individual (race and ethnicity and family income) and structural (growing up in an underresourced neighborhood) measures of marginalization. The findings highlight a need to retain students from marginalized groups in medical school.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Chronic Disease Epidemiology Department, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Candice Chen
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - William A. McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, Geriatrics and Bioethics, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Martinez-Strengel A, Samuels EA, Cross J, Cramer LD, Desai MM, Gotian R, Gross CP, Latimore D, Cavazos JE, Boatright D. Trends in U.S. MD-PhD Program Matriculant Diversity by Sex and Race/Ethnicity. Acad Med 2022; 97:1346-1350. [PMID: 35583935 PMCID: PMC9474393 DOI: 10.1097/acm.0000000000004747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE To examine demographic characteristics of matriculants to U.S. MD-PhD programs by sex and race/ethnicity from academic years (AYs) 2009-2018 and explore the relationships between trends in the percentage of female and underrepresented minority (URM) matriculants to programs with and without Medical Scientist Training Program (MSTP) funding. METHOD Linear regression and time trend analysis of the absolute percentage of matriculants into all U.S. MD-PhD programs was performed for self-reported sex and race/ethnicity, using Association of American Medical Colleges data for AYs 2009-2018, including an interaction for MSTP funding status (yes/no) and year. Linear regression of the percentage of programs matriculating no female or no URM students between AYs 2009 and 2018 was performed, focusing on programs in the top 3 quartiles by size (i.e., those matriculating 4 or more students per year). RESULTS Between AYs 2009 and 2018, the percentage of matriculants to all MD-PhD programs who were female (38.0%-46.0%, 1.05%/year, P = .002) or URM (9.8%-16.7%, 0.77%/year, P < .001) increased. The annual percentage gains of URM matriculants were greater at MSTP-funded programs compared with non-MSTP-funded programs (0.50%/year, P = .046). Moreover, among MD-PhD programs in the top 3 quartiles by size, the percentage of programs with no female matriculants decreased by 0.40% per year ( P = .02) from 4.6% in 2009 to 1.6% in 2018, and the percentage of programs with no URM matriculants decreased by 3.41% per year ( P < .001) from 49% in 2009 to 22% in 2018. CONCLUSIONS A consistent and sustained increase in the percentage of female and URM matriculants to MD-PhD programs from AYs 2009-2018 was observed, but the annual increases in the percentages across groups were small, and the demographics of the MD-PhD workforce still do not reflect the diversity of the U.S. general population.
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Affiliation(s)
- Angela Martinez-Strengel
- A. Martinez-Strengel was a former postdoctoral pediatric hospitalist fellow, National Clinician Scholar Program, Yale School of Medicine, New Haven, Connecticut, at the time of writing. Currently she is a pediatric hospitalist, Randall Children's Hospital, Legacy Health, Portland, Oregon
| | - Elizabeth A Samuels
- E.A. Samuels is assistant professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jeremiah Cross
- J. Cross is a resident doctor, Highland Hospital, Alameda Health System, Oakland, California
| | - Laura D Cramer
- L.D. Cramer is an instructor, National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- M.M. Desai is associate professor, Yale School of Public Health, New Haven, Connecticut
| | - Ruth Gotian
- R. Gotian is chief learning officer and assistant professor of education, Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Cary P Gross
- C.P. Gross is professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Darin Latimore
- D. Latimore is deputy dean and chief diversity officer, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jose E Cavazos
- J.E. Cavazos is professor and assistant dean, South Texas Medical Scientist Training Program, University of Texas Health San Antonio, San Antonio, Texas
| | - Dowin Boatright
- D. Boatright is assistant professor, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Nguyen M, Chaudhry SI, Desai MM, Hajduk AM, McDade WA, Fancher TL, Boatright D. Rates of Medical Student Placement Into Graduate Medical Education by Sex, Race and Ethnicity, and Socioeconomic Status, 2018-2021. JAMA Netw Open 2022; 5:e2229243. [PMID: 36018592 PMCID: PMC9419015 DOI: 10.1001/jamanetworkopen.2022.29243] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This cohort study investigates whether different rates of medical student placement into graduate medical education exist by sex, race and ethnicity, and socioeconomic status from 2018 to 2021.
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Affiliation(s)
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alexandra M. Hajduk
- Section of Geriatrics, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - William A. McDade
- Accrediation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine. Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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Linnander EL, Ayedun A, Boatright D, Ackerman-Barger K, Morgenthaler TI, Ray N, Roy B, Simpson S, Curry LA. Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study. BMC Health Serv Res 2022; 22:975. [PMID: 35907839 PMCID: PMC9338573 DOI: 10.1186/s12913-022-08331-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention. METHODS Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis. DISCUSSION This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.
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Affiliation(s)
- Erika L Linnander
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA.
- Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA.
| | - Adeola Ayedun
- Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Kupiri Ackerman-Barger
- Betty Irene Moore School of Nursing, University of California Davis Health, Sacramento, USA
| | | | | | - Brita Roy
- Department of Medicine, Yale School of Medicine, New Haven, USA
| | - Steven Simpson
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of Kansas, Kansas City, USA
| | - Leslie A Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, USA
- Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA
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Nguyen M, Mason HRC, Barrie U, Jeffe DB, Cavazos JE, Ata A, Boatright D. Association Between Socioeconomic Background and MD-PhD Program Matriculation. J Gen Intern Med 2022; 37:1794-1796. [PMID: 34159550 PMCID: PMC9130359 DOI: 10.1007/s11606-021-06962-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, CT, USA.
| | - Hyacinth R C Mason
- Departments of Medical Education and Family and Community Medicine, Albany Medical College, Albany, NY, USA
| | - Umaru Barrie
- Southwestern MSTP, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jose E Cavazos
- South Texas MSTP, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ashar Ata
- Departments of Surgery and Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Ackerman-Barger K, Goldin P, Draughon-Moret J, London M, Boatright D. Microaggressions, school satisfaction and depression: A national survey of nursing students. Nurs Outlook 2022; 70:496-505. [PMID: 35487768 DOI: 10.1016/j.outlook.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Microaggressions are thought to negatively impact learning and mental health in underrepresented (UR) nursing students. PURPOSE The purpose of this study was to investigate three hypotheses in a sample of nursing students: (a) whether, compared to White nursing students, UR nursing students experienced higher frequency of microaggressions, (b) whether microaggressions predict lesser satisfaction with nursing training and (c) whether microaggressions are associated with higher depression screening scores. METHODS A survey during Summer 2020 assessed 862 nursing students (71.8% female, Mean age = 28.8, SD = 9.27, 61.4% White, 20.0% UR) on microaggressions, satisfaction with their nursing program, and depression symptoms. DISCUSSION We found that compared to White nursing students, UR nursing students reported significantly greater microaggression frequency (with Black students reporting the highest frequency), lesser nursing training satisfaction, and equivalent potential depression rates. CONCLUSION Microaggressions deteriorate indicators of wellbeing, especially in UR nursing students. Strategic action to mitigate microaggressions and promote inclusion is needed.
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Affiliation(s)
| | - Philippe Goldin
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA
| | | | - Maya London
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA
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Bod J, Boatright D. Implementation of a Diversity Committee to Improve Structural Inclusion in an Emergency Medicine Residency. J Adv Med Educ Prof 2022; 10:126-130. [PMID: 35434152 PMCID: PMC9005756 DOI: 10.30476/jamp.2021.93492.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To describe structural changes that can be made in an emergency medicine residency program to increase diversity and foster an inclusive environment. METHODS We established a diversity committee to introduce several simultaneous structural changes focusing on resident recruitment, education and engagement. Some of these changes include establishment of a scholarship to recruit visiting students from diverse backgrounds and a second look weekend for minority applicants. Others focused on ensuring residency didactics, were inclusive and addressed topics pertaining to diversity in emergency medicine. RESULTS We increased the number of minority residents underrepresented in medicine matching in our program from zero to between 2 and 4 annually. We increased the percentage of women matching in our program from 33% to 47%. We worked with residency leadership to increase the number of didactics focusing on diversity and inclusion. CONCLUSIONS Implementation of a Diversity Committee in emergency medicine training programs can be an important tool to improve diversity on a structural level.
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Affiliation(s)
- Jessica Bod
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT, USA
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Abstract
IMPORTANCE The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. OBJECTIVE To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. EXPOSURES Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. MAIN OUTCOMES AND MEASURES Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. RESULTS A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. CONCLUSIONS AND RELEVANCE In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.
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Affiliation(s)
- Caitlin R. Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Stephen Huot
- Office of Graduate Medical Education, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Anderson N, Lett E, Asabor EN, Hernandez AL, Nguemeni Tiako MJ, Johnson C, Montenegro RE, Rizzo TM, Latimore D, Nunez-Smith M, Boatright D. The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students. J Gen Intern Med 2022; 37:298-307. [PMID: 33939079 PMCID: PMC8811096 DOI: 10.1007/s11606-021-06786-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS We conducted a cross-sectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1.48-11.05), and 9.38 (95% CI: 3.71-26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.
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Affiliation(s)
- Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Elle Lett
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Tara M Rizzo
- Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marcella Nunez-Smith
- Department of Internal Medicine and the Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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O’Marr JM, Chan SM, Crawford L, Wong AH, Samuels E, Boatright D. Perceptions on Burnout and the Medical School Learning Environment of Medical Students Who Are Underrepresented in Medicine. JAMA Netw Open 2022; 5:e220115. [PMID: 35195698 PMCID: PMC8867243 DOI: 10.1001/jamanetworkopen.2022.0115] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Burnout is a highly prevalent issue among medical trainees, but there has been limited research characterizing burnout specifically among medical students from groups who are underrepresented in medicine (URIM). OBJECTIVE To assess the association between components of the medical school learning environment and burnout among medical students who are URIM vs those who are not. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional survey study evaluated responses of allopathic medical students graduating from all US allopathic medical schools in 2016 and 2017 to the American Medical Colleges Graduation Questionnaire. Analysis was completed between December 1, 2019, and July 1, 2020. EXPOSURES Self-identification as a medical student who is URIM. MAIN OUTCOMES AND MEASURES Self-reported measures of medical student overall, disengagement, and exhaustion-related burnout using the Oldenburg Burnout Inventory for Medical Students. RESULTS The American Medical Colleges Graduation Questionnaire had an 81% response rate, yielding 26 567 complete participant responses that were included the analysis. A total of 13 645 individuals (51.4%) were male, and 3947 (14.9%) identified as URIM (ie, Alaska Native, Black, Hispanic/Latinx, Native American, and/or Pacific Islander). Medical students who are URIM reported modestly higher levels of exhaustion-related burnout (mean [SD], 11.84 [3.62] vs 11.48 [3.61]; P < .001) and modestly lower mean burnout scores associated with disengagement (mean [SD], 9.24 [3.56] vs 9.36 [3.58]; P = .047). Medical students who are URIM also reported marginally less favorable student-faculty interactions in the learning environment (mean [SD], 14.09 [3.45] vs 14.29 [3.35]; P < .001). Medical students who are URIM were more likely to be in the top quartile of those who experienced exhaustion-related burnout (odds ratio, 1.19 [95% CI, 1.09-1.29]) but less likely to be in the top quartile for disengagement (odds ratio, 0.87 [95% CI, 0.80-0.94]). Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination. CONCLUSIONS AND RELEVANCE This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout. This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility, and/or recurrent discrimination. The learning environment can play a key role in mitigating burnout in both medical students who are URIM and those who are not and is deserving of further research.
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Affiliation(s)
| | | | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dowin Boatright
- Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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47
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Abstract
This study charts the use of the National Institutes of Health’s diversity supplements, grant enhancement awards designed to provide research opportunities to individuals from underrepresented racial or ethnic groups, since the program’s inception in 1989.
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Affiliation(s)
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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48
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Demographic Differences in Medical Students' Perceptions of Respect for Diversity Among Faculty. Acad Med 2021; 96:S218-S219. [PMID: 34705721 DOI: 10.1097/acm.0000000000004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jasmine Weiss
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Lilanthi Balasuriya
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Laura D Cramer
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Marcella Nunez-Smith
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Inginia Genao
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Rosana Gonzalez-Colaso
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Ambrose H Wong
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | | | - Darin Latimore
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Dowin Boatright
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Mona Sharifi
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
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49
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Abreu C, Jawiche J, Nguyen M, Chang AK, Ata A, Reid S, Mason HRC, Rebagliati D, Myers JM, Pinto D, B Jeffe D, Boatright D. Characteristics of medical students interested in emergency medicine with intention to practice in underserved areas. AEM Educ Train 2021; 5:S65-S72. [PMID: 34616975 PMCID: PMC8480495 DOI: 10.1002/aet2.10672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Emergency departments serve a wide variety of racial, ethnic, socioeconomic, and gender backgrounds. It is currently unknown what characteristics of students who express interest in emergency medicine (EM) are associated with a simultaneous desire to work in medically underserved areas. We hypothesize that those who are underrepresented in medicine, are female, learn another language, and have more student debt will be more likely to practice in a medically underserved area. METHODS Data from the National Board of Medical Examiners, Association of American Medical Colleges (AAMC) Student Record System, and the AAMC Graduation Questionnaire were collected on a national cohort of 92,013 U.S. medical students who matriculated from 2007 through 2012. Extracted variables included planned practice area, intention to practice in underserved areas, race/ethnicity, sex, medical school experiences, age at matriculation, debt at graduation, and first-attempt USMLE Step 1 score. RESULTS EM-intending students who identified as female, non-Hispanic Black/African American, or Latinx/Hispanic; had a larger debt at graduation; had experiences with health education in the community; had global health experience; and had learned more than one language were more likely to report an intention to practice in underserved areas. CONCLUSION With the increasing importance of physician diversity to match those of the community being served, this study identifies factors associated with a desire of EM students to work in underserved areas. Medical schools and EM residencies may wish to consider these factors in their admissions process.
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Affiliation(s)
| | | | - Mytien Nguyen
- School of MedicineYale UniversityNew HavenConnecticutUSA
| | - Andrew K. Chang
- Department of Emergency MedicineAlbany Medical CollegeAlbanyNew YorkUSA
| | - Ashar Ata
- Department of Emergency MedicineAlbany Medical CollegeAlbanyNew YorkUSA
| | | | - Hyacinth R. C. Mason
- Office of Student AffairsTufts University School of MedicineBostonMassachusettsUSA
| | | | - Joy M. Myers
- University of Tennessee College of MedicineMemphisTennesseeUSA
| | - Dorcas Pinto
- Department of Emergency MedicineAlbany Medical CollegeAlbanyNew YorkUSA
| | - Donna B Jeffe
- Medical Research Unit, Office of EducationWashington University School of MedicineSt. LouisMissouriUSA
| | - Dowin Boatright
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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50
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Landry A, Boatright D, Smith TY. Call to action in academic emergency medicine: Going beyond the appreciation of diversity, equity, and inclusion to true practice. AEM Educ Train 2021; 5:S7-S9. [PMID: 34616967 PMCID: PMC8480510 DOI: 10.1002/aet2.10671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Alden Landry
- Harvard Medical SchoolBostonMassachusettsUSA
- Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | | - Teresa Y. Smith
- The State University of New York Health Sciences UniversityBrooklynNew YorkUSA
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