A workshop to showcase the diversity of scientists to middle school students

Identity matters in science, technology, engineering, mathematics, and medicine (STEMM) because it can affect an individual's long-term sense of belonging, which may in turn affect their persistence in STEMM. Early K-12 science classes often teach students about the foundational discoveries of the field, which have been predominately made, or at least published, by White men. This homogeneity can leave underrepresented individuals in STEMM feeling isolated, and underrepresented K-12 students may feel as though they cannot enter STEMM fields. This study aimed to examine these feelings of inclusivity in STEMM through an interactive workshop that asked middle schoolers to identify scientists from images of individuals with various racial and gender identities. We found that a plurality of students had a positive experience discussing diversity in science and recognizing underrepresented individuals as scientists.NEW & NOTEWORTHY We observed positive sentiments from middle school students following a workshop that showcased diversity in science. This workshop uniquely encourages students to recognize that physiologists and scientists today are much more diverse than textbooks typically demonstrate and can be adapted for middle schoolers, high schoolers, and college students.

Exploring Underrepresentation: The Role of Diversity Statements in Ophthalmology Residency Programs

INTRODUCTION

The underrepresentation of underrepresented minorities (URMs) in the medical field, particularly in ophthalmology, poses a critical challenge to achieving diversity and equity. While URMs constitute 19% of medical school attendees, their presence is markedly lower in ophthalmology residency programs and among practicing ophthalmologists. This study seeks to investigate the prevalence of diversity statements on ophthalmology residency program websites and their role in the underrepresentation of URMs within the field.

METHODS

This observational, cross-sectional study analyzed the websites of 126 ophthalmology residency programs listed on the San Francisco (SF) Match website. Diversity statements were categorized based on their inclusion of specific underrepresented groups (race or ethnicity, gender, sexual orientation, and disability) and analyzed for correlation with program characteristics. Descriptive statistics and Chi-squared tests were utilized to assess the prevalence of diversity statements and their association with program size, ranking, geographical location, and institutional nature.

RESULTS

Of the 126 programs analyzed, 21 (16.7%) had diversity statements specific to the ophthalmology residency program, and 115 (91.3%) featured institutional-level diversity statements. Race or ethnicity was the most commonly addressed category in diversity statements (75.3%), followed by gender (65.9%), sexual orientation (61.1%), and disability (53.2%). Statistical analyses revealed no significant correlation between program size and the presence of diversity statements. However, higher-ranked programs were more likely to mention sexual orientation and disability. Significant differences were observed at the institutional level, with public institutions more likely to include specific diversity categories.

CONCLUSION

The study highlights a significant disparity in the presence and focus of diversity statements across ophthalmology residency programs. Despite a high prevalence of institutional-level diversity statements, program-specific initiatives are lacking, particularly in addressing disability inclusion. The findings suggest a need for a more comprehensive and targeted effort to address underrepresentation in ophthalmology.

Diversity, Equity, and Inclusion in Healthcare and Academic Radiology: A Critical Examination of Demographic Disparities in 2023

BACKGROUND

Diversity, equity, and inclusion (DEI) are crucial for building a just and equitable healthcare system. However, academic radiology continues to face significant underrepresentation of women and underrepresented minorities (URMs).

PURPOSE

This study examines demographic disparities in academic radiology and presents strategies for improving DEI.

MATERIALS AND METHODS

I analyzed demographic data from various sources and reviewed successful DEI initiatives.

RESULTS

My analysis revealed a significant underrepresentation of URMs and women at all stages of the radiology training pipeline, from medical school to faculty positions. I identified several challenges contributing to this underrepresentation, including implicit bias, financial barriers, and lack of mentorship. However, I also presented successful case studies of initiatives, such as the Radiology Leadership Institute and the Association of University Radiologists Mentorship Program, that are making progress in diversifying the field.

CONCLUSIONS

Achieving DEI in academic radiology requires a multi-pronged approach that includes early outreach, financial aid, mentorship, inclusive recruitment practices, and a focus on creating a welcoming environment. By continuously evaluating and adapting initiatives, the radiology community can create a more equitable and inclusive future for all individuals.

Transplant hepatology and diversity: A decade-long analysis (2013-2022)

Diversity among physicians has been shown to positively impact patient care. Physicians from minority backgrounds are more likely to serve underserved communities and be involved in health disparities research. Efforts to increase the proportion of underrepresented minorities and women in medicine will help prepare a physician workforce that best cares for a diversifying nation. The purpose of this paper was to highlight trends in sex and ethnic representation among incoming U.S. transplant hepatology trainees over a 10-year period.

Palliative Care Clinical Trials in Underrepresented Ethnic and Racial Minorities: A Narrative Review

Introduction: A growing number of patients with serious illness who would benefit from palliative care are part of ethnoracial minority groups. Nevertheless, large disparities in provision of palliative services exist for minoritized populations. Furthermore, there is a relative dearth of palliative care research focused on minority groups and how best to provide high-quality, culturally tailored palliative care. The aim of this narrative review is to summarize the existing literature regarding palliative care clinical trials in underrepresented minority populations, describe methodological approaches, and provide guidance on future palliative care-focused clinical trials. Methods: We used the Scale for the Assessment of Narrative Review Articles (SANRA) and Cochrane's guidelines on conducting reviews. We used PubMed and Clinicaltrials.gov to review published, full-text articles or protocols (1950-2022), and limited to palliative care interventions focused on ethnoracial minority populations. We included randomized clinical trials (RCTs), including pilot and feasibility trials, protocols of RCTs, and studies that report RCT methodology. Two reviewers independently assessed eligibility. Results: Our search yielded 585 publications; of these, 30 met the full-text review criteria and 16 studies met our criteria for inclusion. We deemed nine articles as having low risk of bias and four as having high risk of bias. Discussion: Commonly used methodologic approaches for clinical trials in underrepresented minority populations included the following: the use of written and visual materials that were no higher than a sixth-grade reading level, the use of patient and lay health navigators, bilingual and multicultural study staff and study materials, race-concordant staff, the option of in-person and virtual visits that accommodated the patient and family's schedule, recruitment from faith communities, and the use of community-engaged research principles. Future palliative care clinical trials should expand on the strategies described in this article, adopt effective strategies currently used in nonpalliative care interventions, and innovate around the principles of community-engaged research.

Medical student specialty decision-making and perceptions of neurosurgery. Part 2: Role of race/ethnicity

OBJECTIVE

Although individuals underrepresented in medicine (URM) make up 33% of the United States population, only 12.6% of medical school graduates identify as URM; the same percentage of URM students comprises neurosurgery residency applicants. More information is needed to understand how URM students are making specialty decisions and their perceptions of neurosurgery. The authors aimed to evaluate the differences between URM and non-URM medical students and residents in terms of the factors that contribute to specialty decision-making and perceptions of neurosurgery.

METHODS

A survey was administered to all medical students and resident physicians at a single Midwestern institution to assess factors influencing medical student specialty decision-making and perceptions of neurosurgery. Likert scale responses converted to numerical values on a 5-point scale (strongly agree was the high score of 5) were analyzed with the Mann-Whitney U-test. The chi-square test was performed on the binary responses to examine associations between categorical variables. Semistructured interviews were conducted and analyzed using the grounded theory method.

RESULTS

Of 272 respondents, 49.2% were medical students, 51.8% were residents, and 11.0% identified as URM. URM medical students considered research opportunities more than non-URM medical students in specialty decision-making (p = 0.023). When specialty decision-making factors were assessed, URM residents less strongly considered the technical skill required (p = 0.023), their perceived fit in the field (p < 0.001), and seeing people like them in the field (p = 0.010) than their non-URM counterparts when making specialty decisions. Within both medical student and resident respondent cohorts, the authors found no significant differences between URM and non-URM respondents in terms of their specialty decision-making being affected by medical school experiences such as shadowing, elective rotations, family exposure, or having a mentor in the field. URM residents were more concerned about the opportunity to work on health equity issues in neurosurgery than non-URM residents (p = 0.005). The predominant theme that emerged from interviews was the need for more intentional efforts to recruit and retain URM individuals in medicine and specifically neurosurgery.

CONCLUSIONS

URM students may make specialty decisions differently than non-URM students. URM students were more hesitant toward neurosurgery due to their perceived lack of opportunity for health equity work in neurosurgery. These findings further inform optimization of both new and existing initiatives to improve URM student recruitment and retention in neurosurgery.

Preference for and impact of telehealth vs in-person asthma visits among Black and Latinx adults

BACKGROUND

Black and Latinx adults experience disproportionate asthma-related morbidity and limited specialty care access. The severe acute respiratory syndrome coronavirus 2 pandemic expanded telehealth use.

OBJECTIVE

To evaluate visit type (telehealth [TH] vs in-person [IP]) preferences and the impact of visit type on asthma outcomes among Black and Latinx adults with moderate-to-severe asthma.

METHODS

For this PREPARE trial ancillary study, visit type preference was surveyed by e-mail or telephone post-trial. Emergency medical record data on visit types and asthma outcomes were available for a subset (March 2020 to April 2021). Characteristics associated with visit type preferences, and relationships between visit type and asthma outcomes (control [Asthma Control Test] and asthma-related quality of life [Asthma Symptom Utility Index]), were tested using multivariable regression.

RESULTS

A total of 866 participants consented to be surveyed, with 847 respondents. Among the participants with asthma care experience with both visit types, 42.0% preferred TH for regular checkups, which associated with employment (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.09-2.39; P = .02), lower asthma medication adherence (OR = 1.06; 95% CI, 1.01-1.11; P = .03), and having more historical emergency department and urgent care asthma visits (OR = 1.10 for each additional visit; 95% CI, 1.02-1.18; P = .02), after adjustment. Emergency medical record data were available for 98 participants (62 TH, 36 IP). Those with TH visits were more likely Latinx, from the Southwest, employed, using inhaled corticosteroid-only controller therapy, with lower body mass index, and lower self-reported asthma medication adherence vs those with IP visits only. Both groups had comparable Asthma Control Test (18.4 vs 18.9, P = .52) and Asthma Symptom Utility Index (0.79 vs 0.84, P = .16) scores after adjustment.

CONCLUSION

TH may be similarly efficacious as and often preferred over IP among Black and Latinx adults with moderate-to-severe asthma, especially for regular checkups.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02995733.

Minority Resident Physicians' Perspectives on the Role of Race/Ethnicity, Culture, and Gender in Their Surgical Training Experiences

BACKGROUND

Female and racial/ethnic minority representation in surgical programs continues to trail behind other medical specialties. Various structural and perceived obstacles which contribute to a difficult path for underrepresented minority (URM) trainees have been identified, and efforts to reduce these hurdles are underway. Gaining perspective and insight from current surgical minority trainees may add valuable insight to aid with improving and innovating strategies to recruit and retain URM surgeons.

OBJECTIVE

To characterize how race/ethnicity, cultural background, and gender affect the surgical training experience of URM surgical residents in all areas of surgery a focus on the field of Orthopedic Surgery, given its particularly poor rates of diversity.

METHODS

Authors conducted semi-structured video interviews on current surgical residents or fellows who were members of underrepresented populations including Female, African-American/Black, Latino, Asian, Native American, and First or Second-generation immigrant status. Recruitment was achieved through a combination of voluntary, convenience, and snowball sampling procedures. Interview transcripts were then coded using conventional thematic analysis. Themes were iteratively expanded into subthemes and subsequently categorized utilizing a pile-sorting methodology.

RESULTS

Among 23 surgical trainees 12 self-identified as Black (60.9%), 5 as Asian (17.4%), 1 as Hispanic (4.4%), and 5 as Caucasian (17.4%). Twelve residents identified as male (52%) and 11 as female (48%). Six surgical specialties were represented with the majority of participants (83%) being trainees in surgical subspecialties, among those orthopedic surgery was most strongly represented (57%). Analysis of their responses revealed 4 major themes: positive experiences, problems related to minority status, coping strategies, and participant suggested interventions. Themes were distilled further to sub-themes. Positive experiences' sub-themes included finding a supportive community, pride in minority status, and being able to better relate to patients. Negative experiences related to minority status' subthemes included perceived microaggressions and additional pressures, such as greater scrutiny and harsher punishments relative to their nonminority counterparts, which negatively impacted their surgical training. Most respondents did not feel there were dedicated resources to help alleviate these additional burdens, so some sought help outside of their training programs while others tried to assimilate, and others felt isolated. Recommended proposed interventions included validating the URM resident experience, providing education/training, and creating opportunities for mentorship.

IMPLICATIONS/CONCLUSIONS

URM surgical trainees face numerous challenges related to their minority status. Recruitment and retention of URM in medicine would benefit from individual early and longitudinal mentorship, mitigating imposter syndrome, acknowledging the challenges faced by residents, and seeking feedback from both past and current residents.

Reaching Populations to Address Disparities in Cancer Care Delivery: Results From a Six-Site Initiative

BACKGROUND

Large segments of the US population do not receive quality cancer care due to pervasive and systemic inequities, which can increase morbidity and mortality. Multicomponent, multilevel interventions can address inequities and improve care, but only if they reach communities with suboptimal access. Intervention studies often underenroll individuals from historically excluded groups.

METHODS

The Alliance to Advance Patient-Centered Cancer Care includes 6 grantees across the United States who implemented unique multicomponent, multilevel intervention programs with common goals of reducing disparities, increasing engagement, and improving the quality of care for targeted populations. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework informed the evaluation efforts across sites. Each Alliance site identified their intended populations, which included underrepresented minorities (eg, Black and Latinx persons), individuals who prefer a language other than English, and rural residents. We evaluated the demographic characteristics of participants to determine program reach.

RESULTS

Between 2018 and 2020, a total of 2,390 of 5,309 potentially eligible participants were enrolled across the 6 sites. The proportion of enrolled individuals with selected characteristics included 38% (n=908) Black adults, 24% (n=574) Latinx adults, 19% (n=454) preferring a language other than English, and 30% (n=717) rural residents. The proportion of those enrolled who were the intended population was commensurate to the proportion with desired characteristics in those identified as potentially eligible.

CONCLUSIONS

The grantees met or exceeded enrollments from their intended populations who have been underserved by quality cancer care into patient-centered intervention programs. Intentional application of recruitment/engagement strategies is needed to reach individuals from historically underserved communities.

Home Away From Home: Mentorship and Research in Private Practices for Students Without Home Programs

As the competitiveness of matching to an otolaryngology residency continues to climb, students are encouraged to seek mentorship and research within their home institution. This notion, however, does not account for students without a home otolaryngology program or department. Here, we present a research model where medical students conduct clinical research and gain experience and mentorship within a local otolaryngology private practice. Over the span of 6 years, rotating students produced an average of 3 research projects per year. Fourth-year medical students within the practice had an average of 20.5 publications, exceeding the 2020 National Residency Match Program's metrics for matched otolaryngology applicants. Private practices may provide research and mentorship for students with limited resources. Similarly, physicians who oversee such students may gain added help to conduct research within their practice. This symbiotic relationship may serve in advancing evidence-based clinical practice while amplifying the diverse voices of students otherwise seldom heard.

Accelerating diversity, equity, and inclusion goals: a qualitative assessment from the lens of scientists at the 2020 Clinical Translational Science Awards Annual Meeting

Participants in the leadership breakout session at the Clinical Translational Science Awards (CTSA) virtual 2020 conference discussed and ranked six recommendations in terms of feasibility, impact, and priority for advancing Diversity, Equity, and Inclusion (DEI) efforts to elevate underrepresented populations to leadership positions in CTSAs and their broader institutions. A thematic analysis of chat and polling data identified challenges and opportunities to achieve DEI goals, with the three most promising recommendations as: cross-institutional Principal Investigator (P.I.) action-learning workgroups, transparent policies for recruiting and promoting underrepresented minorities (URM) leadership, and a clear succession plan to nurture and elevate URM leaders. Suggestions are made to improve DEI in CTSA leadership and allow for greater representation in the translational science field.

Strategies for change: thriving as an individual with a disabilty in STEMM

Disability remains an underacknowledged and underdiscussed topic in science, technology, engineering, mathematics, and medicine (STEMM). Social stigma and fear of negative outcomes have resulted in a consistent lack of disclosure. Disabilities cause social and professional difficulties for those that have them. While some faculty can be allies, past literature shows that steps must be taken to make disabilities visible in STEMM at both student and faculty levels. Here, we offer suggestions to better support faculty and students in enhancing the outcomes of individuals who have invisible disabilities. Critically, techniques such as abolishing stigma, universal learning, and better mentoring may improve the challenges faced by those who self-identify as an individual with a disability.

Palliative care of COVID-19 patients with do-not-resuscitate status in underrepresented minorities

BACKGROUND

The impact of the COVID-19 pandemic on palliative care intervention (PCIs) in patients with do-not-resuscitate (DNR) status remains uncertain.

METHODS

Case-control study of patients with DNR order with RT-PCR confirmed SARS-COV2 infection (cases), and those with DNR order but without SARS-COV2 infection (controls). The primary outcome measures included timing and delivery of PCIs, and secondary measures included pre-admission characteristics and in-hospital death.

RESULTS

The ethnicity distribution was comparable between 69 cases and 138 controls, including Black/African Americans (61% vs. 44%), Latino/Hispanics (16% vs. 26%) and White (9% vs. 20%) (trend-p = .54). Cases were employed more (17% vs. 6%, adjusted-p = .012), less frail (fit 47% vs. 21%; mildly frail 22% vs. 36%; frail 31% vs. 43%, trend-p = .018) and had fewer comorbidities than controls. Cases had higher chances of intensive care unit admission (HR 1.76 [95% CI: 1.03-3.02]) and intubation (53% vs. 30%, p = .002), lower chances to be seen by palliative care team (HR .46 [.30-.70]) and a longer time to palliative care visit than controls (β per ln-day .67 [.00-1.34]). In the setting of no-visiting hospitals policy, we did not find significant increase in utilisation of video conferencing (22% vs. 13%) and religious services (12% vs. 12%) both in case and in controls.

CONCLUSION

Do-not-resuscitate patients with COVID-19 had better general health and higher employment status than 'typical' DNR patients, but lower chances to be seen by the palliative care team. This study raises a question of the applicability of the current palliative care model in addressing the needs of DNR patients with COVID-19 during the pandemic.

Perspectives on Justice, Equity, Diversity, and Inclusion (JEDI): A call for oral health care policy

Educational Institutions in the U.S. have responded to government policies that called for more inclusive educational systems. The goal is to reduce the oppression created by "racism" and enhance the environmental trajectory toward equity and justice. Although significant social and economic advances have been made, these have not been sustainable, and disparities remain. As educational systems have not kept pace with the demographics and economic trends, there is a call to action to affirm the need to establish policies that support diversity within pipeline pathways, faculty recruitment, and retention. Leveraging knowledge and networking across institutions with communities can transform academic cultures, reduce unconscious/implicit bias, and microaggression. As racism exists in every segment of our culture, building sustainable capacity and a system proportional to the populations' relative needs can help chart a direction forward for policies that support justice, equity, diversity, and inclusion among dental institutions.

Descriptors in Letters of Recommendation for Otolaryngology Residency Across Gender, Race, and Time

OBJECTIVE

To determine whether differences exist in the descriptors used in letters of recommendations for Otolaryngology - Head and Neck Surgery (OHNS) residency candidates, comparing race and gender as depicted in visual letters of recommendation (VLORs) from the 2014 and 2019 application cycles.

DESIGN

Four hundred thirty-three LORS (284 narrative LORs and 149 standardized LORs) and 63 medical student performance evaluations for 104 candidates who interviewed at the University of Cincinnati OHNS residency program in 2014 and 2019 were analyzed. Descriptors from LORs and medical student performance evaluations were collected by two reviewers and QSR NVivo 12 was used to generate a word cloud that grouped words by synonym and weighted them by frequency. Reviewers coded these synonyms into one of eight descriptor categories. Race and gender were self-reported from residency applications. The average of each category frequency for each race and gender were compared using student t-tests.

SETTING

University of Cincinnati OHNS Residency Program.

PARTICIPANTS

104 OHNS applicants that interviewed at the University of Cincinnati in 2014 and 2019.

RESULTS

Of the 104 candidates reviewed, 39 were female (37.5%). 66/104 (63%) of applicants identified as white, 31/104 (30%) as non-white, and 7/104 (7%) preferred not to say. No significant differences were found between male vs female descriptors. However, white applicants had more "leadership" descriptors (1.3% vs 0.5%, p = 0.01) and fewer "intelligence" words (6.6% vs 4.8%, p = 0.02) than non-white applicants. Applicants in 2019 were described with more team player (14.2% vs 9.6%, p < 0.0001), leadership (1.6% vs 0.7%, p = 0.047), and reserved (1.7% vs 0.7%, p = 0.02) words, but fewer grindstone (25.2% vs 32.1%, p < 0.0001) and ability/agentic (27.9% vs 32.6%, p < 0.0001) words than applicants in 2014.

CONCLUSIONS

In VLORs for OHNS residency, male and female applicants are described similarly, but white applicants are described as leaders more frequently and as intelligent less frequently than non-white counterparts. Regardless, it is encouraging to see applicants described with a more humanistic vocabulary in 2019.

How well do urology residency program webpages recruit underrepresented minorities?

INTRODUCTION

Historically, the field of medicine has suffered from a lack of diversity. This project examines if urology residency program websites were actively attempting to recruit underrepresented minority applicants with the hypothesis that while some programs would attempt to attract such applicants on their website, the majority would not.

MATERIALS AND METHODS

A cross-sectional analysis of program webpages for information regarding underrepresented minorities was performed. Electronic Residency Application Service residency database was used to identify 130 urology residency programs. Three were no longer accepting residents and were not included. The publicly available webpages of 137 urology residency training programs identified were reviewed.

RESULTS

Only 26.3% (36) of programs included any information regarding diversity or inclusion on their webpage. The most common references to diversity were a link to a Department of Diversity and Inclusion (28, 20.4%) and information regarding a "commitment to diversity" (28, 20.4%). Only two programs included all seven categories searched for.

CONCLUSIONS

Residency program websites may be an important tool to recruit underrepresented minorities and currently there is significant room for improvement. Given that urology is already behind other fields in terms of representation, it is especially important to make an active, visible attempt to recruit underrepresented minorities.

Representation of Racial and Ethnic Minority Populations in Dementia Prevention Trials: A Systematic Review

Despite older racial and ethnic minorities (REMs) being more likely to develop dementia they are underrepresented in clinical trials focused on neurological disorders. Inclusion of REMs in dementia prevention studies is vital to reducing the impact of disparities in dementia risk. We conducted a systematic review to characterize the number of REM enrolled in brain health and prevention randomized controlled trials (RCTs). RTCs published from January 1, 2004 to April 21, 2020 were included. Participants were normal cognitive adults aged 45 years and older who participated in a Phase II or Phase III U.S. based preventative trial. Analyses were performed to examine differences in trial characteristics between RCTs that did and those that did not report race/ethnicity and to calculate the pooled proportion of each racial/ethnic group in randomized brain healthy prevention trials. A total of 42 studies consisting of 100,748 participants were included in the final analyses. A total of 26 (62%) reported some racial/ethnic identity data. The pooled proportion of REM participants was 0.256 (95% CI, 0.191, 0.326). There is a lack of racial/ethnic reporting of participants and REMs remain underrepresented in brain health prevention RCTs.

The Role of Implicit Bias in Surgical Resident Evaluations

BACKGROUND

Implicit bias is a key factor preventing the advancement and retention of women and underrepresented minorities in academic surgery.

PURPOSE

We examined the role of implicit bias in the technical component of the residency performance evaluation. The Fundamentals of Laparoscopic Surgery (FLS) score, an objective measure of technical performance, was compared to the subjective technical skills (TS) score given by attending surgeons.

PROCEDURES

FLS scores and the average TS scores from chief resident evaluations at a university program were analyzed from 2015 to 2019 (n = 29 residents; female 22%, underrepresented minorities 27%).  The average TS score for each resident was calculated, scores dichotomized above and below the mean for the program and analyzed across gender and racial identity.

MAIN FINDINGS

There were no significant differences in FLS or TS scores between male and female trainees or racial identity. The Kappa correlation coefficient between the 2 dichotomized scores was significantly lower for female (-0.50) versus male (0.23) trainees (p < 0.01); it was not significantly different between racial groups (p = 0.34).

PRINCIPAL CONCLUSIONS

There was statistically significant difference in agreement between the FLS and TS scores of individual female and male trainees, suggesting the presence of implicit bias in our pilot study. Further research with a larger sample size is warranted.

OBJECTIVE

To investigate the presence of implicit bias against women and underrepresented minorities in the technical component of the residency performance evaluation. We hypothesized that women and underrepresented racial minorities would have lower subjective technical skills (TS) scores as compared to their objective FLS scores, relative to the mean for the training program.

DESIGN

FLS scores and the average TS scores from chief resident performance evaluations were analyzed from 2015-2019. Both FLS and the average TS scores were dichotomized above and below the mean for the program and analyzed across gender and racial identity.  Research was approved by institutional IRB.

SETTING

This study was conducted at the University of Arizona General Surgery Residency Program at Banner University Medical Center in Tucson, Arizona. This is a tertiary care university training program.

PARTICIPANTS

Educational records of graduated general surgery chief residents from 2015 to 2019 were accessed for the study. We analyzed 37 TS scores from attending performance evaluations and 29 FLS scores reported to the program during the study period (22% female, 27% underrepresented racial minorities).

RESULTS

There were no significant differences in FLS or TS scores between male and female trainees or racial identity. The Kappa correlation coefficient between the 2 dichotomized scores was significantly lower for female (-0.50) versus male (0.23) trainees (p < 0.01); it was not significantly different between racial groups (p = 0.34).

CONCLUSIONS

There was a statistically significant difference in agreement between the FLS and TS score of individual female and male trainees, suggesting the presence of implicit bias in this pilot study. Further research with a larger sample size is warranted.

An Inside Look: Qualitative Study of Underrepresented in Medicine Recruitment Strategies used by OB-GYN Program Directors

INTRODUCTION

Since 2019, the Accreditation Council for Graduate Medical Education has mandated that all residency programs develop initiatives to recruit underrepresented in medicine (URiM) applicants to increase diversity among physicians. The literature has described a variety of recruitment strategies, but the underlying viewpoints of leaders most responsible for these efforts have not been characterized. We aimed to describe the experience and perspective of program directors around URiM recruitment.

METHODS

We conducted a qualitative analysis of 14 semi-structured interviews with OB-GYN program directors recruited electronically about their perspectives on URiM recruitment between August 2018 and October 2019. We coded audio transcripts from these interviews in an independent and iterative fashion. Using inductive content analysis, we derived several themes.

RESULTS

Fourteen OB-GYN program directors participated. Themes arising from data included an acknowledgement of the contextual nature of diversity, which included not just race but also other forms of self-identity; the visual nature of recruitment efforts; the lack of consistent support for programs despite shared goals in workforce diversity; the imperative of upending traditional approaches to recruitment (e.g., undue emphasis on Step 1 scores); and finally, the prerequisites of a critical mass of URiM residents, faculty diversity and supportive culture for successful URiM recruitment.

DISCUSSION

Our findings shed light on the motivations and obstacles that program directors face in URiM recruitment, underscoring a need for more broad-based initiatives to ensure that society is served by a healthcare workforce reflecting the diversity of our patients.

Effect of Application Screening Methods on Racial and Ethnic Diversity in Otolaryngology

Otolaryngology-head and neck surgery (OHNS) lags behind other surgical subspecialties in the representation of underrepresented minorities in medicine (URMs). Given the recently announced changes to Step 1 scoring, we aimed to assess the effect of alternative application screening methods-Step 2 Clinical Knowledge scores and Alpha Omega Alpha membership-on the racial/ethnic diversity of the OHNS applicant pool. After reviewing OHNS residency applications submitted to our institution for the 2015-2020 matches (N = 2177), we determined that a significantly greater proportion of URM vs non-URM applicants would be screened out from interview consideration if any the following were used as an initial screening method: Step 2 cutoff score of 240, Step 2 cutoff score of 253 or non-Alpha Omega Alpha membership (P < .01 for each). Given that using these metrics to screen applications disproportionately affects URMs, programs should consider implementing alternative application review methods, such as holistic evaluation, which may promote more equitable distribution of interviews.

Salary disparities based on gender in academic emergency medicine leadership

OBJECTIVE

There are significantly fewer women than men in leadership roles in health care. Previous studies have shown that, overall, male physicians earn nearly $20,000 more annually than their female physician colleagues after adjusting for confounding factors. However, there has not been a description of physician leadership compensation in relation to gender.

METHODS

This was a successive cross-sectional observation study design of 154 emergency departments in the United States from 5 years (2013, 2015-2018) using Association of Academic Chairs in Emergency Medicine and Academy of Administrators in Academic EM survey data. The primary variable of interest, leadership role, was attained by recoding the survey responses to assign primary job duty into four main categories: no leadership role, operations leadership, education leadership, and executive leadership.

RESULTS

Overall, 8820 responses were included. Across all survey years, the mean (±SD) percentage of women in any leadership role was significantly less than men (44.5% [95% CI: 42.8, 46.2%] vs. 55.3% [95% CI: 54.1, 56.5%]). Women in leadership roles worked more clinical hours than men in the same position (female median = 1008, male median = 960). Women also had significantly lower salaries than men at each of the 5-year time points that data are reported, with unadjusted mean salary differences of -$54,409 per year for executives, -$27,803 for operational leaders, and -$17,803 for education leaders.

CONCLUSIONS

Female physicians hold fewer leadership roles in academic emergency medicine (EM), and when they do, they work more clinical hours and are paid less than male physicians. As a specialty, EM should continue to investigate and report on gender achievement disparities as work is done to rectify the system inequalities.

Understanding Questions and Concerns Regarding COVID-19 and the COVID-19 Vaccine Among Populations Presenting at a COVID-19 Vaccine Clinic Hub: A Qualitative Study

BACKGROUND

Skepticism among the public surrounding the COVID-19 vaccine is still prevalent despite vaccine-positive communication and many Americans having already received the vaccine. Side effects of the vaccine, as well as its expeditious research and development, are among the top concerns among those hesitant to receive the coronavirus vaccine. Moreover, there is additional concern regarding the association between comorbidities and severity of illness due to the coronavirus pandemic.

OBJECTIVE

We aimed to describe the pandemic- and vaccine-related concerns of South Texas residents who attended the UT Health San Antonio School of Nursing's vaccine clinic with the goal of better understanding vaccine-related misconceptions and hesitancy for subsequent vaccination campaigns and boosters.

METHODS

An electronic survey accessible via a QR code on printed flyers was distributed throughout the waiting areas and post-vaccine observation rooms within the COVID-19 vaccine clinic at UT Health San Antonio School of Nursing from April 5 to 16, 2021. The survey contained a primary open-ended question designed to obtain information on concerns of the clinic attendees regarding the COVID-19 pandemic and COVID-19 vaccine. A thematic analysis was performed on the qualitative data to identify major themes to better understand concerns of vaccine clinic visitors.

RESULTS

During the 11-day period, 510 attendees received vaccinations through the vaccination clinic and completed the survey. Five areas of concern were identified by the 277 attendees: immunity, future vaccinations, vaccine symptoms and safety, protocol post-vaccination, and child vaccinations. Post-hoc sentiment analysis showed that responses were generally neutral or negative.

CONCLUSION

This study provides a perspective regarding questions and concerns of South Texas residents regarding the COVID-19 pandemic, the vaccine, and their general health status within a vaccinated population. Vaccine recipients were found to still have questions even after receiving the vaccine, suggesting that eliminating uncertainty surrounding the COVID-19 vaccine is not necessary to motivate individuals to receive the vaccine. Instead, addressing concerns through public health messaging could be a useful strategy to address vaccine-related concerns and increase subsequent vaccine uptake in future vaccination campaigns and boosters.

Understanding Differences in Underrepresented Minorities and First-Generation Student Perceptions in the Introductory Biology Classroom

We used quantitative methods to better understand the perceptions of students in an introductory biology course (Biology 101) at a small, liberal arts college (SLAC) that is also a primarily white institution (PWI). In pre/post surveys, we asked students questions related to their attitudes and beliefs about their professor, classmates, and Biology 101. We were especially interested in the responses and outcomes of underrepresented minorities (URM) and first-generation (FG) students. Our findings suggest URM and FG students have a decreased sense of belonging and increased perceptions of exclusion and differential treatment due to race. These findings can explain, in part, the disparity in Biology 101 grade and STEM (science, technology, engineering, and math) attrition.

Red Blood Cell Metabolism in Pyruvate Kinase Deficient Patients

Background: Pyruvate kinase deficiency (PKD) is the most frequent congenital enzymatic defect of glycolysis, and one of the most common causes of hereditary non spherocytic hemolytic anemia. Therapeutic interventions are limited, in part because of the incomplete understanding of the molecular mechanisms that compensate for the metabolic defect.

Methods: Mass spectrometry-based metabolomics analyses were performed on red blood cells (RBCs) from healthy controls (n=10) and PKD patients (n=5).

Results: In PKD patients, decreases in late glycolysis were accompanied by accumulation of pentose phosphate pathway (PPP) metabolites, as a function of oxidant stress to purines (increased breakdown and deamination). Markers of oxidant stress included increased levels of sulfur-containing compounds (methionine and taurine), polyamines (spermidine and spermine). Markers of hypoxia such as succinate, sphingosine 1-phosphate (S1P), and hypoxanthine were all elevated in PKD subjects. Membrane lipid oxidation and remodeling was observed in RBCs from PKD patients, as determined by increases in the levels of free (poly-/highly-unsaturated) fatty acids and acyl-carnitines.

Conclusion: In conclusion, in the present study, we provide the first overview of RBC metabolism in patients with PKD. Though limited in scope, the study addresses the need for basic science to investigate pathologies targeting underrepresented minorities (Amish population in this study), with the ultimate goal to target treatments to health disparities.

"The odds were stacked against me": a qualitative study of underrepresented minorities in surgical training

BACKGROUND

The Royal Australasian College of Surgeons (RACS) is expected to provide surgical care to a diverse patient population across Australia and New Zealand (ANZ). To improve the quality-of-care individuals receive, the surgical workforce must reflect the population it serves. Achieving diversity within RACS will strengthen therapeutic relationships with patients and promote an inclusive culture. This study investigates the perspectives of underrepresented minority (URM) trainees to highlight barriers for the selection and completion of the RACS Surgical Education and Training (SET) program.

METHODS

This qualitative study used online, semi-structured, in-depth interviews of URM trainees. Participants were recruited by self-identification and were invited to participate based on inclusion criterion. Interviews took place between August and October 2020, were transcribed and de-identified. Framework analysis was used to identify themes.

FINDINGS

Eight participants from four surgical specialities were interviewed, six from Australia and two from New Zealand. There were six female and two male participants. The findings identified barriers that were grouped into eight broad areas: discouragement; structural racism, discrimination and unconscious bias; language barriers; policies and procedures; lack of role models; homophobia; sexual harassment and women in surgery.

CONCLUSION

The findings offer guidance to RACS and the surgical community to explore new strategies to improve the experience of URM SET trainees. While on a small scale, the study draws directly on the URMs' experiences to inform strategies addressing equity, diversity and inclusion. The aim is to produce a diverse surgical workforce that better delivers healthcare services to a diverse population.

Diversity and Inclusion: A Review of Effective Initiatives in Surgery

OBJECTIVE

Surgery lacks women and racial minorities that are underrepresented in medicine (UIM). This systematic review evaluates interventions used to promote diversity in surgery.

DESIGN

The PubMed (MEDLINE), EMBASE, and Cochrane databases were searched for studies (1) describing interventions for increasing UIM and gender diversity, (2) within surgery, and (3) targeting any learner prior to residency.

SETTING

Nine surgical specialties were searched: general, neurosurgery, plastics, orthopedics, otolaryngology, urology, cardiothoracic, vascular, and ophthalmology.

RESULTS

Of the 982 studies identified, 16 were included. Awards, clerkships, and workshops were each described by three studies; awards funded research or travel to national meetings, clerkships referred to a third- or fourth-year rotation that provided exposure to surgery, and workshops were hands-on skills sessions for learners. Two studies proposed a holistic review of residency applications, which involves emphasizing an individual's attributes and life experiences rather than strictly academics. Two studies detailed a longitudinal mentoring program comprised of mentorship throughout medical school plus opportunities for research, lectures, and workshops. One study described a combination of interventions and the remaining 2 presented interventions that were characterized as "other." Longitudinal mentoring programs significantly increased the likelihood of women and UIM applying to surgical residency, while holistic review significantly increased the numbers of women and UIM being interviewed and ranked by residency programs. One award increased the number of female residents matriculating into surgical residency. Clerkships significantly increased the number of women applying to surgical residency. The mere mention of diversity initiatives on a program's website was associated with more female surgical residents, but not UIM residents. Workshops led to a higher, but not statistically significant, proportion of women applying to surgery.

CONCLUSION

Holistic review and longitudinal mentoring programs are the most effective interventions for increasing UIM and female representation among surgical trainees.

Striving for Diversity: National Survey of OB-GYN Program Directors Reporting Residency Recruitment Strategies for Underrepresented Minorities

OBJECTIVE

To characterize strategies among OB-GYN residency programs to recruit underrepresented minorities in medicine, the relative effectiveness of these approaches, and the associated barriers to recruitment.

DESIGN

We conducted a survey to solicit strategies from OB-GYN PDs at 253 United States (U.S.) accredited programs for recruiting underrepresented minorities in medicine (URiM) applicants. We also sought their relative effectiveness and barriers to recruitment.

SETTING

A national survey of U.S. accredited residency programs in OB-GYN in 2017-2018.

RESULTS

A total of 56 (22% response rate) PDs responded. Programs reported either "some" or "significant emphasis" on URiM recruitment (77%), with only 32% employing specific recruitment strategies. Fifteen (83%) reported using race and/or ethnicity data in the U.S.'s centralized electronic residency application service, 10 (56%) recruiting applicants from URiM association events, 9 (50%) meeting with potential URiMs prior to official interviews, and 5 (28%) offering a second visit. Efforts perceived to be most effective were second visits (39%), identifying race/ethnicity in electronic residency application service (33%), URiM recruitment events (28%), and individual phone calls (22%). Barriers included the lack of applicant pool (32%), lack of department diversity (29%) and lack of institutional diversity (30%).

CONCLUSIONS

This systematic collation of URiM recruitment practices and perceptions of their effectiveness represents a toolbox of options for residency programs to consider in diversifying their workforce.

Equity for women and underrepresented minorities in STEM: Graduate experiences and career plans in chemistry

On June 10, 2020, as part of the Black Lives Matter movement, scientists in the United States and throughout the world paused to consider how systematic racism affects the scientific enterprise. As a result, many academic departments are now assessing policies and practices that may contribute to this situation. This paper provides evidence of the nature of inequities related to race–ethnicity and gender in graduate school experiences and career plans of PhD students in one science, technology, engineering, and math (STEM) discipline, chemistry. The results can help promote understanding of the problems and guide efforts toward equity within STEM and, potentially, other academic areas. In turn, these changes can strengthen the scientific enterprise and the well-being of society.

Recent events prompted scientists in the United States and throughout the world to consider how systematic racism affects the scientific enterprise. This paper provides evidence of inequities related to race–ethnicity and gender in graduate school experiences and career plans of PhD students in the top 100 ranked departments in one science, technology, engineering, and math (STEM) discipline, chemistry. Mixed-model regression analyses were used to examine factors that might moderate these differences. The results show that graduate students who identified as a member of a racial/ethnic group traditionally underrepresented in chemistry (underrepresented minorities, URM) were significantly less likely than other students to report that their financial support was sufficient to meet their needs. They were also less likely to report having supportive relationships with peers and postdocs. Women, and especially URM women, were significantly less likely to report supportive relationships with advisors. Despite their more negative experiences in graduate school, students who identified as URM expressed greater commitment to finishing their degree and staying in the field. When there was at least one faculty member within their departments who also identified as URM they were also more likely than other students to aspire to a university professorship with an emphasis on research. Men were significantly more likely than women to express strong commitment to finishing the PhD and remaining in chemistry, but this difference was stronger in top-ranked departments. Men were also more likely than women to aspire to a professorship with an emphasis on research, and this difference remained when individual and departmental-level variables were controlled.

Diversity in orthopaedic trauma: where we are and where we need to be

Diversity has multiple dimensions, and individuals' interpretation of diversity varies broadly. The Orthopaedic Trauma Association (OTA) leadership recognized the need to address issues of diversity within the organization and appointed the OTA Diversity Committee in 2020. The OTA Diversity Committee has produced a statement that was confirmed by the OTA's board of directors reflecting the organization's position on diversity: "The OTA promotes and values diversity and inclusion at all levels with the goal of creating an environment where every member has the opportunity to excel in leadership, education, and culturally-competent orthopaedic trauma care." The OTA Diversity Committee surveyed its 1907 OTA members in the United States and Canada to assess its membership's attitudes toward and interpretation of this important topic.

METHODS

Two surveys were distributed. One 15-question survey was sent to 1907 OTA members with different membership categories in the United States and Canada requesting basic demographic information and asking how members felt about the degree to which women and underrepresented minorities (URM) are represented within the OTA and within its leadership. A second 11-question survey was sent to 30 past chairs of 2017-2019 OTA educational courses and meetings evaluating their criteria for choosing faculty for OTA courses. Comments were reviewed and summarized to identify recurring themes.

RESULTS

Two hundred seven responses from the membership and 14 from course chairs were received from the 1907 surveys that were emailed to OTA members in the United States and Canada. The results reveal awareness of the limited female and URM representation within the OTA. However, there is disagreement in how or even whether this should be addressed at an organizational level. Review of comments from both surveys reveals a number of common themes on these important topics.

CONCLUSION

The members and course chairs surveyed recognize that there is limited diversity at the OTA leadership and faculty level. Many members feel that the OTA would benefit from increasing female and URM representation in committees, within the leadership, and as faculty at OTA-sponsored courses. However, survey comments reveal that many members and course chairs feel it is not the organization's role to regulate diversity and that diversity initiatives themselves may introduce an unnecessary form of bias.

Modifiable Barriers for Recruitment and Retention of Older Adults Participants from Underrepresented Minorities in Alzheimer's Disease Research

Clinical Alzheimer's disease (AD) trials currently face a critical shortfall of thousands of eligible participants, which inflates the duration and cost of the clinical study as well as threatens the scientific merit of promising clinical interventions. This recruitment crisis is further compounded by the fact that underrepresented and marginalized populations-particularly those identifying as a racial or ethnic minority, those with low socioeconomic status, or living in rural areas-have been historically underrepresented in ongoing AD clinical trials despite overwhelming evidence that such populations are at increased risk for developing dementia. As a result of various recruitment barriers, current AD clinical studies frequently reflect a decreasingly representative segment of the US population, which threatens the overall generalizability of these findings. The current narrative review provides an updated examination and critique of common recruitment barriers and potential solutions, as well as a discussion of theoretical approaches that may address barriers disproportionately experienced by underrepresented communities. AD clinical researchers are encouraged to take purposive action aimed at increasing diversity of enrolled AD clinical trial cohorts by actively identifying and quantifying barriers to research participation-especially recruitment barriers and health disparities that disproportionately prevent underrepresented and marginalized populations from participating in research. Furthermore, researchers are encouraged to closely track which individuals who express interest in AD research ultimately enroll in research studies to examine whether AD research participation is appropriately representative of the intended population for whom these new and novel AD interventions are being designed.

Analysis of Linguistically and Culturally Tailored Initiatives in Websites of Kidney Transplant Programs in the United States Between 2013-2018

INTRODUCTION

Minority patients constitute the majority of the kidney transplant waiting list, yet they suffer greater difficulties in listing and longer wait times to transplantation. There is a lack of information regarding targeted efforts by transplant centers to improve transplant care for minority populations.

RESEARCH QUESTION

Our aim was to analyze all kidney transplant websites in the United States to identify changes over a 5-year period in the number of multilingual websites, reported culturally targeted initiatives, and center and provider diversity.

DESIGN

Surveys were developed to analyze center websites of all transplant programs in the United States. Those with incomplete information about their nephrology or surgical teams were excluded, resulting in 174 (73%) sites in 2013 and 185 (76%) in 2018. Results: Few websites were available in a language other than English, 6.3% in 2013 and 9.7% in 2018 (P = 0.24). Only 3 websites (1.3%) in 2013 and 7 (3.7%) in 2018 reported any evidence of a culturally targeted initiative (P = 0.23). In 2018, 35% of centers employed a Hispanic transplant physician, 77% had a transplant physician who spoke a language other than English, and 39% had a transplant physician who spoke Spanish.

DISCUSSION

Although minority patients are expected to grow in the United States, decreased access to transplantation continues to vex the transplant community. Very little progress has been made in the development of multilingual websites and culturally targeted initiatives.

Mentorship and Training to Increase Diversity of Researchers and Practitioners in the Field of Aging and Alzheimer's Disease: A Scoping Review of Program Characteristics

Objectives: Diversity is needed within the aging and Alzheimer's disease and related dementias (ADRD) research and practice workforce to comprehensively address health inequities faced by underrepresented minority (URM) older adults. We conducted a scoping review of training programs designed to diversify the pool of researchers and practitioners in the field of aging and ADRD. Methods: Online database searches yielded 3976 articles published from 1999 to 2019. Fourteen studies met the inclusion criteria. Results: All programs were from the United States and included URM populations. Nine programs included students, one targeted university faculty, and four targeted clinical staff. Only five programs were guided by theory. Discussion: Our review identified URMs' desire for culturally diverse and representative mentorship, the need for career development support at various training stages, and the importance of incorporating theory to program design. It also identified key characteristics for future program development, creation of systematic evaluation standards, and opportunities for promotion.

Process, outcome, and impact evaluation of the ohio state university DentPath postbaccalaurate program

Despite the progress in increasing racial and ethnic diversity in dental school programs in the United States, minority dental students still remain underrepresented when compared with the total population. As a result, dental education programs have been attempting to increase the number of students from underrepresented and underserved communities in their programs.

PURPOSE

The purpose of this study was to conduct process, outcome, and impact evaluations of the Ohio State University (OSU) College of Dentistry's (CoDs) DentPath Program.

METHODS

Upon Institutional Review Board approval, this study utilized a computer-assisted telephone interview research design of graduates from the OSU CoD DentPath Program. Forty closed and open-ended questions were asked during the structured interview. Descriptive and thematic analyses were used to analyze the data.

RESULTS

The data from 25 eligible graduates were analyzed, which represented a 100% response rate. Process evaluation revealed 100% (n = 25) of the participants expressed satisfaction with their DentPath experiences and recommendations for improvement were provided. Outcome evaluation revealed the participants treated patients using Medicaid (range: 20%-90%, n = 5) or a sliding scale (range: 5%-85%, n = 3) for payment and 36% (n = 9) of the participants regularly treated underserved populations outside of their regular practice settings. Impact evaluation revealed 68% (n = 17) participants reported the DentPath Program had no impact on their practice location.

CONCLUSIONS

Future research is needed to determine methods to promote the transition of DentPath students through dental school and into underserved communities.

A Peer-Led Social Media Intervention to Improve Interest in Research Careers Among Urban Youth: Mixed Methods Study

BACKGROUND

Novel methods to boost interest in scientific research careers among minority youth are largely unexplored. Social media offers a unique avenue toward influencing teen behavior and attitudes, and can therefore be utilized to stimulate interest in clinical research.

OBJECTIVE

The aim of this study was to engage high-achieving minority youth enrolled in a science pipeline program to develop a targeted social media marketing campaign for boosting interest in clinical research careers among their peers.

METHODS

Students enrolled in the Training Early Achievers for Careers in Health program conducted focus groups in their communities to inform themes that best promote clinical research. They then scripted, storyboarded, and filmed a short video to share on social media with a campaign hashtag. Additionally, each student enrolled peers from their social circle to be subjects of the study. Subjects were sent a Career Orientation Survey at baseline to assess preliminary interest in clinical research careers and again after the campaign to assess how they saw the video, their perceptions of the video, and interest in clinical research careers after watching the video. Subjects who did not see the video through the online campaign were invited to watch the video via a link on the postsurvey. Interest change scores were calculated using differences in Likert-scale responses to the question "how interested are you in a career in clinical research?" An ordinal logistic regression model was used to test the association between watching a peer-shared video, perception of entertainment, and interest change score controlling for underrepresented minorities in medicine status (Black, American Indian/Alaska Native, Native Hawaiian, or Pacific Islander), gender, and baseline interest in medical or clinical research careers.

RESULTS

From 2014 to 2017, 325 subjects were enrolled as part of 4 distinct campaigns: #WhereScienceMeetsReality, #RedefiningResearch, #DoYourResearch, and #LifeWithoutResearch. Over half (n=180) of the subjects watched the video via the campaign, 227/295 (76.9%) found the video entertaining, and 92/325 (28.3%) demonstrated baseline interest in clinical research. The ordinal logistic regression model showed that subjects who viewed the video from a peer (odds ratio [OR] 1.56, 95% CI 1.00-2.44, P=.05) or found the video entertaining (OR 1.36, 95% CI 1.01-1.82, P=.04) had greater odds of increasing interest in a clinical research career. Subjects with a higher baseline interest in medicine (OR 1.55, 95% CI 1.28-1.87, P<.001) also had greater odds of increasing their interest in clinical research.

CONCLUSIONS

The spread of authentic and relevant peer-created messages via social media can increase interest in clinical research careers among diverse teens. Peer-driven social media campaigns should be explored as a way to effectively recruit minority youth into scientific research careers.

Active learning narrows achievement gaps for underrepresented students in undergraduate science, technology, engineering, and math

Achievement gaps increase income inequality and decrease workplace diversity by contributing to the attrition of underrepresented students from science, technology, engineering, and mathematics (STEM) majors. We collected data on exam scores and failure rates in a wide array of STEM courses that had been taught by the same instructor via both traditional lecturing and active learning, and analyzed how the change in teaching approach impacted underrepresented minority and low-income students. On average, active learning reduced achievement gaps in exam scores and passing rates. Active learning benefits all students but offers disproportionate benefits for individuals from underrepresented groups. Widespread implementation of high-quality active learning can help reduce or eliminate achievement gaps in STEM courses and promote equity in higher education.

We tested the hypothesis that underrepresented students in active-learning classrooms experience narrower achievement gaps than underrepresented students in traditional lecturing classrooms, averaged across all science, technology, engineering, and mathematics (STEM) fields and courses. We conducted a comprehensive search for both published and unpublished studies that compared the performance of underrepresented students to their overrepresented classmates in active-learning and traditional-lecturing treatments. This search resulted in data on student examination scores from 15 studies (9,238 total students) and data on student failure rates from 26 studies (44,606 total students). Bayesian regression analyses showed that on average, active learning reduced achievement gaps in examination scores by 33% and narrowed gaps in passing rates by 45%. The reported proportion of time that students spend on in-class activities was important, as only classes that implemented high-intensity active learning narrowed achievement gaps. Sensitivity analyses showed that the conclusions are robust to sampling bias and other issues. To explain the extensive variation in efficacy observed among studies, we propose the heads-and-hearts hypothesis, which holds that meaningful reductions in achievement gaps only occur when course designs combine deliberate practice with inclusive teaching. Our results support calls to replace traditional lecturing with evidence-based, active-learning course designs across the STEM disciplines and suggest that innovations in instructional strategies can increase equity in higher education.

A CTSA-based consultation service to advance research on special and underserved populations

In this report, we describe the implementation and short-term outcomes of a Special Populations Consultation Service within the University of California, Los Angeles (UCLA) Clinical and Translational Science Institute (CTSI). With the goal of increasing the quality and quantity of special population (SP) research, the UCLA CTSI Integrating Special Populations program designed a consultation service to support faculty and trainees conducting research involving one of three CTSI “special populations:” children, older adults, and/or minority; underserved; or health disparity populations. The Special Populations Consultation Service offers three types of activities: grant proposal studios, career consultations, and project reviews. UCLA CTSI faculty with appropriate content expertise serve as consultants. We evaluated this consultation model using satisfaction surveys and by quantifying funded grants and reported changes in career goals in SP research. Between 2016 and 2019, the Special Populations Consultation Service provided 59 consultations including 42 grant studios and was used by researchers at all levels from all four UCLA CTSI institutions. Recipients rated the consultations very highly. Funding success rates were 57% following K-level grant studios and 28% following R-level grant studios. Users of project and career consultations commonly attributed career accomplishments in part to their consultation experiences. The SP Consultation Service is feasible and acceptable and appears to enhance careers of investigators studying special populations.

Underrepresented Minorities are Underrepresented Among General Surgery Applicants Selected to Interview

OBJECTIVE

Diversity is an ill-defined entity in general surgery training. The Accreditation Council for Graduate Medical Education recently proposed new common program requirements including verbiage requiring diversity in residency. "Recruiting" for diversity can be challenging within the constraints of geographic preference, type of program, and applicant qualifications. In addition, the Match process adds further uncertainty. We sought to study the self-identified racial/ethnic distribution of general surgery applicants to better ascertain the characteristics of underrepresented minorities (URM) within the general surgery applicant pool.

DESIGN

Program-specific data from the Electronic Residency Application Service was collated for the 2018 medical student application cycle. Data were abstracted for all participating programs' applicants and those selected to interview. Applicants who did not enter a self-identified race/ethnicity were excluded from analysis. URM were defined as those identifying as Black/African American, Hispanic/Latino/of Spanish origin, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander-Samoan. Appropriate statistical analyses were accomplished.

SETTING

Ten general surgery residency programs-5 independent programs and 5 university programs.

PARTICIPANTS

Residency applicants to the participating general surgery residency programs.

RESULTS

Ten surgery residency programs received 10,312 applications from 3192 unique applicants. Seven hundred and seventy-eight applications did not include a self-identified race/ethnicity and were excluded from analysis. The racial/ethnic makeup of applicants in this study cohort was similar to that from 2017 to 2018 Electronic Residency Application Service data of 4262 total applicants to categorical general surgery. Programs received a median of 1085 (range: 485-1264) applications each and altogether selected 617 unique applicants for interviews. Overall, 2148 applicants graduated from US medical schools, and of those, 595 (28%) were offered interviews. The mean age of applicants was 28.8 ± 3.8 years and 1316 (41%) were female. Hispanic/Latino/of Spanish origin, Black, and American Indian/Alaskan Native/Hawaiian/Pacific Islander-Samoan applicants constituted 12%, 8%, and 1% of total applicants, but only 8%, 6%, and 1% of those selected for interview. Overall, 29% of applicants had United States Medical Licensing Examination (USMLE) Step 1 scores ≤220; 37 (6%) of those selected for interviews had a USMLE Step 1 score of ≤220. A higher proportion of URM applicants had USMLE scores ≤220 compared to White and Asian applicants. Non-white self-identification was a significant independent predictor of a lower likelihood of interview selection. Female gender, USMLE Step 1 score >220, and graduating from a US medical school were associated with an increased likelihood of being selected to interview.

CONCLUSIONS

URM applicants represented a disproportionately smaller percentage of applicants selected for interview. USMLE Step 1 scores were lower among the URM applicants. Training programs that use discreet USMLE cutoffs are likely excluding URM at a higher rate than their non-URM applicants. Attempts to recruit racially/ethnically diverse trainees should include program-level analysis to determine disparities and a focused strategy to interview applicants who might be overlooked by conventional screening tools.

Evaluation of a Spanish Health Topics Course for Undergraduate Pre-health Latino Students

Introduction: Language concordance between doctors and patients and increased matriculation of underrepresented minorities in medical school are commonly cited goals of medical centers and medical schools in addressing health disparities for individuals with limited English proficiency. Pre-medical education may represent a high-yield untapped opportunity to address both through a Spanish Health Topics, or Temas de Salud, course for Latino pre-health students. 

Methods: The authors implemented a longitudinal course for pre-health, Latino, undergraduate students to prepare them for success in bilingual health careers. The course included educational components of health knowledge, Spanish terminology, Hispanic/Latino sociocultural context, and exposure to medical learning formats presented during monthly sessions spread out over two years. A post-course survey with comfort and knowledge assessments was administered after each one-year cycle of the program. 

Results: One hundred and sixteen students (57%) out of 203 course-participants responded to the Spanish Health Topics course survey. The student comfort level and self-perceived knowledge about specific health issues increased for both students of native-level Spanish and less advanced fluency, though a larger improvement was noted in several health topics for native speakers. Eighty-five percent of students reported perceiving the class to be useful for their future careers, and 92% of respondents indicated having applied learned concepts in social and/or academic settings outside of class.

Discussion: Most students reported benefits of the course. Future studies should focus on a more detailed evaluation of enrolled students’ knowledge, attitudes, confidence, and long-term retention compared to students in a standard premedical path. Temas de Salud may enhance the bilingual, bicultural skillset of Latino underrepresented minorities in medicine, and can be replicated at other institutions.

Traditional vs. Affiliation Paths Model for Science Student Success

The availability of academic and personal supports is known to have a positive impact on students' academic success, which can be particularly beneficial in the university setting. In the present study, we propose that participation in a university academic and climate support program increases students' academic success in the Science, Technology, Engineering, and Math (STEM) fields. The aim is to answer two research questions about the dynamics of the university setting as it relates to traditional higher education versus targeted support program's affiliation paths. Results gathered by comparing two groups (Minority Opportunities in REsearch (MORE)) programs affiliates versus non-MORE (or essentially traditional degree program paths), indicate that students affiliated with the university target program have much higher graduation rates. 88% of MORE students graduated in 6 years and 100% within 10 years, compared to non-MORE traditional students with 16% graduating in 6 years and 28% graduating within 10 years. Concerning the second research question of interest, all MORE STEM majors were compared by major while controlling for entry status of freshmen versus transfers. A two-way ANOVA showed there were no differences by major pointing to the generalizability of this type of support program.

Cornelia de Lange syndrome in diverse populations

Cornelia de Lange syndrome (CdLS) is a dominant multisystemic malformation syndrome due to mutations in five genes-NIPBL, SMC1A, HDAC8, SMC3, and RAD21. The characteristic facial dysmorphisms include microcephaly, arched eyebrows, synophrys, short nose with depressed bridge and anteverted nares, long philtrum, thin lips, micrognathia, and hypertrichosis. Most affected individuals have intellectual disability, growth deficiency, and upper limb anomalies. This study looked at individuals from diverse populations with both clinical and molecularly confirmed diagnoses of CdLS by facial analysis technology. Clinical data and images from 246 individuals with CdLS were obtained from 15 countries. This cohort included 49% female patients and ages ranged from infancy to 37 years. Individuals were grouped into ancestry categories of African descent, Asian, Latin American, Middle Eastern, and Caucasian. Across these populations, 14 features showed a statistically significant difference. The most common facial features found in all ancestry groups included synophrys, short nose with anteverted nares, and a long philtrum with thin vermillion of the upper lip. Using facial analysis technology we compared 246 individuals with CdLS to 246 gender/age matched controls and found that sensitivity was equal or greater than 95% for all groups. Specificity was equal or greater than 91%. In conclusion, we present consistent clinical findings from global populations with CdLS while demonstrating how facial analysis technology can be a tool to support accurate diagnoses in the clinical setting. This work, along with prior studies in this arena, will assist in earlier detection, recognition, and treatment of CdLS worldwide.

Graduation and Academic Placement of Underrepresented Racial/Ethnic Minority Doctoral Recipients in Public Health Disciplines, United States, 2003-2015

OBJECTIVES

Given public health's emphasis on health disparities in underrepresented racial/ethnic minority communities, having a racially and ethnically diverse faculty is important to ensure adequate public health training. We examined trends in the number of underrepresented racial/ethnic minority (ie, non-Hispanic black, Hispanic, American Indian/Alaska Native, Native Hawaiian, and Pacific Islander) doctoral graduates from public health fields and determined the proportion of persons from underrepresented racial/ethnic minority groups who entered academia.

METHODS

We analyzed repeated cross-sectional data from restricted files collected by the National Science Foundation on doctoral graduates from US institutions during 2003-2015. Our dependent variables were the number of all underrepresented racial/ethnic minority public health doctoral recipients and underrepresented racial/ethnic minority graduates who had accepted academic positions. Using logistic regression models and adjusted odds ratios (aORs), we examined correlates of these variables over time, controlling for all independent variables (eg, gender, age, relationship status, number of dependents).

RESULTS

The percentage of underrepresented racial/ethnic minority doctoral graduates increased from 15.4% (91 of 592) in 2003 to 23.4% (296 of 1264) in 2015, with the largest increase occurring among black graduates (from 6.6% in 2003 to 14.1% in 2015). Black graduates (310 of 1241, 25.0%) were significantly less likely than white graduates (2258 of 5913, 38.2%) and, frequently, less likely than graduates from other underrepresented racial/ethnic minority groups to indicate having accepted an academic position (all P < .001).

CONCLUSIONS

Stakeholders should consider targeted programs to increase the number of racial/ethnic minority faculty members in academic public health fields.

Academic Career Progression of Chinese-Origin Pharmacy Faculty Members in Western Countries

Background: The field of Pharmacy education is experiencing a paucity of underrepresented minorities (URMs) faculty worldwide. The aim of this study is to investigate the current professional status of Chinese-origin pharmacy faculty members, who are considered as a good model of URMs at pharmacy academia in western countries, and identify the influencing factors to their academic career progression in academic careers. Methods: An online questionnaire was sent to Chinese-origin academic staffs at pharmacy schools in US, UK, Canada, Australia, and New Zealand. The survey comprised demographic information, educational background, and the influencing factors to academic career progression. Results: The vast majority of Chinese faculty members who worked in US were male. Individuals with junior academic title comprised the largest proportion. Over 75% of Chinese-origin pharmacy academics were involved in scientific disciplines (e.g., pharmaceutics, pharmacology, and medicinal chemistry). Usually, Chinese-origin academic members spent 4 years obtaining their first academic jobs after finishing PhD degree, and need 5⁻6 years to get academic promotion. The contributing factors of academic promotion were high quality publications and external funding. Conclusion: Our research offers a deep insight into academic career progression for URMs and give some valuable advice for their pharmacy academic paths.

Diversity of Graduates from Bachelor's, Master's and Doctoral Degree Neuroscience Programs in the United States

The demography of United States graduates from science, technology, engineering, and math (STEM) degree programs is well-understood; however, data particularly describing the gender and ethnic diversity of graduates of neuroscience programs has not been analyzed, limiting our knowledge of specific areas where diversity and fair representation are lacking. Using over 30 years of data from the National Center for Education Statistics, we documented the demography of neuroscience graduates from bachelor's, master's, and doctoral degree programs. Recent graduation trends indicate greater numbers of female graduates from bachelor's and graduate degree programs. White (non-Hispanic) males and females represent the largest group of graduates while Asian/Pacific Islanders represent the largest non-White group of graduates. Although the number of underrepresented minorities graduating from neuroscience degree programs at every level has increased in recent years, they still lag compared to White (non-Hispanic) and Asian/Pacific Islanders. These data provide valuable information that can be used to promote greater diversity among neuroscience graduates by higher education faculty and administrators and federal funding agencies.

National Heart, Lung, and Blood Institute Workshop Summary: Enhancing Opportunities for Training and Retention of a Diverse Biomedical Workforce

RATIONALE

Committed to its mission of conducting and supporting research that addresses the health needs of all sectors of the nation's population, the Division of Lung Diseases, National Heart, Lung, and Blood Institute of the National Institutes of Health (NHLBI/NIH) seeks to identify issues that impact the training and retention of underrepresented individuals in the biomedical research workforce.

OBJECTIVES

Early-stage investigators who received grant support through the NIH Research Supplements to Promote Diversity in Health Related Research Program were invited to a workshop held in Bethesda, Maryland in June, 2015, in order to (1) assess the effectiveness of the current NHLBI diversity program, (2) improve its strategies towards achieving its goal, and (3) provide guidance to assist the transition of diversity supplement recipients to independent NIH grant support.

METHODS

Workshop participants participated in five independent focus groups to discuss specific topics affecting underrepresented individuals in the biomedical sciences: (1) Socioeconomic barriers to success for diverse research scientists; (2) role of the academic research community in promoting diversity; (3) life beyond a research project grant: non-primary investigator career paths in research; (4) facilitating career development of diverse independent research scientists through NHLBI diversity programs; and (5) effectiveness of current NHLBI programs for promoting diversity of the biomedical workforce.

MEASUREMENTS AND MAIN RESULTS

Several key issues experienced by young, underrepresented biomedical scientists were identified, and solutions were proposed to improve on training and career development for diverse students, from the high school to postdoctoral trainee level, and address limitations of currently available diversity programs. Although some of the challenges mentioned, such as cost of living, limited parental leave, and insecure extramural funding, are also likely faced by nonminority scientists, these issues are magnified among diversity scientists and are complicated by unique circumstances in this group, such as limited exposure to science at a young age, absence of role models and mentors from underrepresented backgrounds, and social norms that relegate their career endeavors, particularly among women, to being subordinate to their expected cultural role.

CONCLUSIONS

The factors influencing the participation of underrepresented minorities in the biomedical workforce are complex and span several continuous or overlapping stages in the professional development of scientists from these groups. Therefore, a multipronged approach is needed to enable the professional development and retention of underrepresented minorities in biomedical research. This approach should address both individual and social factors and should involve funding agencies, academic institutions, mentoring teams, professional societies, and peer collaboration. Implementation of some of the recommendations, such as access to child care, institutional support and health benefits for trainees, teaching and entrepreneurial opportunities, grant-writing webinars, and pre-NIH career development (Pre-K) pilot programs would not only benefit biomedical scientists from underrepresented groups but also improve the situation of nondiverse junior scientists. However, other issues, such as opportunities for early exposure to science of disadvantaged/minority groups, and identifying mentors/life coaches/peer mentors who come from similar cultural backgrounds and vantage points, are unique to this group.

Culturally Competent Strategies for Recruitment and Retention of African American Populations into Clinical Trials

PURPOSE

To identify successful recruitment strategies, challenges and best practices for researchers to engage African American communities in clinical studies taken into consideration target participants' culture and context.

METHODS

We reviewed 50 studies conducted from 2001 to 2012 at an inner-city research center to determine the type, duration, anticipated enrollments and actual enrollments. Survey was sent to study coordinators to obtain data on recruitment and retention strategies, challenges and dropout rates. We also interviewed 25 study coordinators on challenges and strategies.

RESULTS

Of the 50 studies, 24 had completed recruitment at the time of this report. The completed studies achieved a median recruitment rate of 88% (range: 50-110). Successful recruitment and retention strategies included: field-based strategy and snowballing. Major barriers were: distrust, compensation, education disadvantage, lack of interest, and inability to have study partner. Strategies to reduce barriers included providing informational sessions, disseminating newsletters about study outcomes. Best practices include being culturally sensitive including demonstrating a caring attitude and being responsive to participants needs.

CONCLUSIONS

Cultural competence is critical in order to design and implement successful recruitment strategies in this population. Research teams should consist of multiethnic staff, involve the community, demonstrate trust and deliver concise education of the research endeavor.

Improving diversity, inclusion, and representation in radiology and radiation oncology part 1: why these matter

The ACR Commission for Women and General Diversity is committed to identifying barriers to a diverse physician workforce in radiology and radiation oncology (RRO), and to offering policy recommendations to overcome these barriers. In Part 1 of a 2-part position article from the commission, diversity as a concept and its dimensions of personality, character, ethnicity, biology, biography, and organization are introduced. Terms commonly used to describe diverse individuals and groups are reviewed. The history of diversity and inclusion in US society and health care are addressed. The post-Civil Rights Era evolution of diversity in medicine is delineated: Diversity 1.0, with basic awareness, nondiscrimination, and recruitment; Diversity 2.0, with appreciation of the value of diversity but inclusion as peripheral or in opposition to other goals; and Diversity 3.0, which integrates diversity and inclusion into core missions of organizations and their leadership, and leverages its potential for innovation and contribution. The current states of diversity and inclusion in RRO are reviewed in regard to gender, race, ethnicity, sexual orientation, and gender identity. The lack of representation and unchanged demographics in these fields relative to other medical specialties are explored. The business case for diversity is discussed, with examples of successful models and potential application to the health care industry in general and to RRO. The moral, ethical, and public health imperative for diversity is also highlighted.

Increasing the relative weight of noncognitive admission criteria improves underrepresented minority admission rates to medical school

CONSTRUCT: The objective of this study was to evaluate the impact of varying the relative weights of cognitive versus noncognitive admission criteria on the proportion of underrepresented minorities admitted to medical school. It answers the question, "Can medical schools increase the admission rates of underrepresented minority (URM) students by balancing cognitive criteria with the experiences, attributes, and metrics of noncognitive data in the admission process?"

BACKGROUND

U.S. demographics are shifting, and by 2042 ethnic minority groups will make up approximately 50% of the population. Increasing diversity of the U.S. population foreshadows the need to increase the number of physicians from underrepresented minorities to help address healthcare disparities that are on the rise.

APPROACH

A cohort of three medical school applicant classes (2007-2009) was used to model the impact on URM admission rates as the relative weights of cognitive and noncognitive admission criteria were varied. This study used the minimum admission standards established for the actual incoming classes. The URM rate of admission to medical school was the outcome. Cognitive criteria included Medical College Admission Test scores and grade point averages. Noncognitive criteria included four categories: background and diversity, interest and suitability for a career in medicine, problem-solving and communication skills, and letters of recommendation.

RESULTS

A cohort of 480 applicants from the three applicant classes were enrolled in the study. As the weighting scheme was varied from 50% cognitive/50% noncognitive weights to 35%/65%, the proportion of URM students accepted to medical school increased from 24% (42/177) to 30% (57/193; p < .001). Hispanic and Native American acceptance rates increased by 5.1% and 0.7%, respectively.

CONCLUSIONS

Admission rates of URM students can be increased by weighting noncognitive higher relative to cognitive criteria without compromising admission standards. Challenging conventional practice in the admissions process may improve health disparities and diversify the physician workforce.

Culturally Diverse Undergraduate Researchers' Academic Outcomes and Perceptions of Their Research Mentoring Relationships

Few studies have empirically investigated the specific factors in mentoring relationships between undergraduate researchers (mentees) and their mentors in the biological and life sciences that account for mentees' positive academic and career outcomes. Using archival evaluation data from more than 400 mentees gathered over a multi-year period (2005-11) from several undergraduate biology research programs at a large, Midwestern research university, we validated existing evaluation measures of the mentored research experience and the mentor-mentee relationship. We used a subset of data from mentees (77% underrepresented racial/ethnic minorities) to test a hypothesized social cognitive career theory model of associations between mentees' academic outcomes and perceptions of their research mentoring relationships. Results from path analysis indicate that perceived mentor effectiveness indirectly predicted post-baccalaureate outcomes via research self-efficacy beliefs. Findings are discussed with implications for developing new and refining existing tools to measure this impact, programmatic interventions to increase the success of culturally diverse research mentees and future directions for research.