Moral injury and the hidden curriculum in medical school: comparing the experiences of students underrepresented in medicine (URMs) and non-URMs

Underrepresented students in medicine (URM) have more negative perceptions of the medical school learning environment (LE), a phenomenon that can contribute to higher rates of burnout and attrition in these populations. The hidden curriculum (HC)-defined as a set of values informally conveyed to learners through clinical role-modeling-is a LE socialization construct that has been critically examined for its role in shaping students' professional identities. Yet differences in how URMs and non-URMs experience the HC remain underexplored. The study used a pragmatic approach that drew on elements of grounded theory and employed both deductive and inductive reasoning. Investigators conducted qualitative, semi-structured interviews with a purposive sample of 13 URM and 21 non-URM participants at a Bronx, NY medical school. Interviews examined student experiences and reactions to the HC. Both cohorts witnessed patient disparagement and mistreatment. However, from these encounters, URM participants expressed more moral injury-the adverse emotional consequence of feeling pressured to accept ideologically incongruent values. URMs were also more likely to describe resisting the HC. Differences in group reactions appeared to arise from URMs' identity resonance with patients' lived experiences. Participants across cohorts emphasized increasing URM recruitment as one step toward mitigating these circumstances. URM participants experienced more distress and offered more resistance to the HC relative to non-URMs. The etiology of these differential reactions may stem from relative barriers in negotiating personal and professional identities. As such, URMs' perceptions of the LE may be adversely impacted given their more negative interactions with the HC.

A 10-year analysis of the racial distribution of authors in plastic surgery research and the impact of minority mentorship

BACKGROUND

This study evaluates the racial distribution in Plastic and Reconstructive Surgery (PRS) publication authorship and illustrates the impact underrepresented in medicine (URiM) mentorship has on increasing diverse trainee contributions to the PRS peer-reviewed literature.

METHODS

Articles published in the seven highest-impact PRS peer-reviewed journals within the last 10 years (2012-2022) were reviewed and analyzed for first and senior authors' race and ethnicity, publication year, and citation count.

RESULTS

A total of 23,549 publications were identified of which 8250 were from the US-based institutions. A random sampling of 778 publications (∼10 ​%) were scrutinized for first and senior author race and ethnicity. Across all journals, 64.5 ​% of senior authors were White, 29.9 ​% Asian, 4.6 ​% Hispanic, and 1.0 ​% Black. First authors were 59.5 ​% White, 32.8 ​% Asian, 5.2 ​% Hispanic, and 2.6 ​% Black (p=<0.0001). The presence of a URiM senior author increased the likelihood of a URiM first author 7-fold (p=<0.0001); 95 ​% CI [3.5-14.0]). There was no statistically significant difference in the total citation count relative to author race or ethnicity. The Aesthetic Surgery Journal had the greatest proportion of White senior authors (73.6 ​%), while Microsurgery had the highest percentage of URiM senior authors (8.7 ​%).

CONCLUSIONS

URiM authorship of PRS publications is limited and mentorship is essential to improve underrepresented perspectives in the PRS peer-reviewed literature.

Building an Equity-Centered Ecosystem: University of Utah Health as a Microcosm

Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.

Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine

BACKGROUND

Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce.

METHODS

Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05.

RESULTS

First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures.

CONCLUSION

Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

Diversity in the Cardiothoracic Surgery Workforce: What I Can Do

Within the cardiothoracic surgery workforce, there are significant gaps in the numbers of women and underrepresented in medicine minorities, but some progress has been made in gender diversity at the resident level. Individual surgeons play an important role in combatting discrimination and harassment, while also promoting women and minorities through mentorship and sponsorship. More importantly, a multifaceted and structured approach is needed to increase diversity at the institutional level with strategies to create a culture of inclusion, working to retain underrepresented minority and female surgeons, and eliminating bias in the recruitment process.

Healthcare disparities encountered by patients with headache disorders and potential mitigation strategies

This chapter discusses the healthcare disparities in headache medicine and proposes solutions to mitigate them. Disparities exist in the diagnosis, treatment, and outcomes of underserved patients with migraine and other headache disorders. Systemic racism, provider bias and lack of cultural sensitivity, a history of mistrust and historical injustices, lack of research of underrepresented groups, lack of diversity in clinical and research realms as well as leadership positions within national institutions and organizations all contribute to the ongoing disparities in headache medicine. Making strides in increasing the diversity of the clinical and research workforce, training providers on cultural sensitivity, providing mentorship programs to underrepresented groups in headache medicine, increasing funding for headache medicine disparity research, and facilitating participation of underrepresented groups in research are all potential ways to address disparities.

Applying holistic review practices to a Combined Baccalaureate/Medical Degree Program: Reflections on lessons learned

PROBLEM

Despite the implementation of holistic review in the medical school application process, there is little information about how this can be utilized in Combined Baccalaureate/Medical Degree pipeline programs, especially since many programs offer reserved spots to their students in the medical school. Implementing holistic review in a Combined Baccalaureate/Medical Degree program and intentionally structuring it to align with the medical school mission and admissions practices and processes, can improve the diversification of the physician workforce, contribute to more primary care doctors, and promote in-state practice.

INTERVENTION

Utilizing the medical school admissions by-laws, committee structure, shared training, and educational processes, we successfully engrained in our committee members the values and mission alignment to select the best applicants to fulfill the medical school mission using holistic review. To our knowledge, no other program has written about how holistic review is used in Combined Baccalaureate/Medical Degree programs and how it contributes to program outcomes.

CONTEXT

The Combined Baccalaureate/Medical Degree Program is a partnership between the undergraduate College of Arts and Sciences and the School of Medicine. The Combined Baccalaureate/Medical Degree admissions committee is a subcommittee of the School of Medicine admissions committee but has a separate membership. Hence, the holistic admissions process for the program mirrors the School of Medicine admissions process. To determine the outcome of this process, we analyzed practice specialty, practice location, gender, race and ethnicity of program alumni.

IMPACT

To date, the Combined Baccalaureate/Medical Degree holistic admissions processes have supported the medical school mission, "…To meet the physician workforce needs of the state by selection of students who are likely to train in specialty areas of need and to remain in or return to the areas of our state needing physicians." This implementation has resulted in 75% (37/49) of our practicing alumni selecting a primary care specialty, and 69% (34/49) practicing in the state. In addition, 55% (27/49) identify as Underrepresented in Medicine.

LESSONS LEARNED

We observed that having an intentional structured alignment in place allowed for implementation of holistic practices in the Combined Baccalaureate/Medical Degree admissions process. The high retention rates and specialty of graduates from the Combined Baccalaureate/Medical Degree Program support our intentional efforts to diversify our admissions committees and align the Combined Baccalaureate/Medical Degree program's holistic review admissions process with our School of Medicine mission and admissions practices and processes, as key strategies to reach our diversity-related goals.

The Current State of Workforce Diversity and Inclusion in Pediatric Critical Care

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.

Diversity, Equity, and Inclusion Initiatives in Dermatology Organizations

Over the past few years, there have been concerted efforts to increase diversity in the field of dermatology. This has been achieved through the creation of Diversity, Equity, and Inclusion (DEI) initiatives in dermatology organizations that strive to provide resources and opportunities for trainees who are underrepresented in medicine. This article compiles the ongoing DEI initiatives in the American Academy of Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology Society, Society for Investigative Dermatology, Skin of Color Society, American Society for Dermatologic Surgery, The Dermatology Section of the National Medical Association, and Society for Pediatric Dermatology.

Impostor syndrome among minority medical students who are underrepresented in medicine

OBJECTIVES

Impostor syndrome (IS) is prevalent in medical professionals. However, little is known about the prevalence of IS among medical trainees and those who are underrepresented in medicine (UiM). Even less is known about the experiences of UiM students at predominantly white institutions (PWIs) and historically black colleges/universities (HBCUs) relative to their non-UiM peers. The purpose of this study is to investigate differences in impostor syndrome among UiM and non-UiM medical students at a PWI and a HBCU. We additionally explored gender differences in impostor syndrome among UiM and non-UiM students at both institutions.

METHOD

Medical students (N = 278) at a PWI (N = 183, 107 (59%) women) and a HBCU (N = 95, 60 (63%) women), completed an anonymous, online two-part survey. In part one, students provided demographic information, and in part two, students completed the Clance Impostor Phenomenon Scale, a 20-item self-report questionnaire that assessed feelings of inadequacy and self-doubt surrounding intelligence, success, achievements, and one's inability to accept praise/recognition. Based on the student's score, the level of IS was measured and placed into one of two levels: few/moderate IS feelings, or frequent/intense IS feelings. We conducted a series of chi-square tests, binary logistic regression, independent sample t-tests, and analysis of variance to test the main aim of the study.

RESULTS

The response rate was 22% and 25% at the PWI and HBCU, respectively. Overall, 97% of students reported moderate to intense feelings of IS, and women were 1.7 times more likely than men to report frequent or intense feelings of IS (63.5% vs 50.5%, p = 0.03). Students at PWI were 2.7 times more likely to report frequent or intense IS than HBCU students (66.7% vs 42.1%, p< 0.01). In addition, UiM students at PWI were 3.0 times more likely to report frequent or intense IS compared to UiM students at HBCU (68.6 % vs 42.0%, p = 0.01). Computation of a three-way ANOVA with gender, minority status, and school type revealed a two-way interaction indicating that UiM women scored higher on impostor syndrome than UiM men at the PWI and HBCU. This trend was not observed among non-UiM students.

CONCLUSIONS

Impostor syndrome is informed by gender, UiM status, as well as environmental context. Efforts to provide supportive professional development for medical students should be directed towards understanding and combatting this phenomenon at this critical juncture of their medical career.

Perceptions of Otolaryngology Residency Among Students Underrepresented in Medicine

OBJECTIVE

Otolaryngology-Head and Neck Surgery (OHNS) has historically been one of the least diverse surgical subspecialties. The objective of this study was to better understand perceptions of OHNS from underrepresented students in medicine (URiM) and identify factors affecting URiM application to the specialty.

STUDY DESIGN

Survey via electronic questionnaire.

METHODS

An anonymous, 22-question electronic survey was administered nationally to URiM medical students (N = 388) regarding factors that play a role in developing an interest in applying to OHNS. Responses to questions were compared between URiMs applying to OHNS and those applying to other fields.

RESULTS

Thirty-six percent of respondents identified as African American and 26% as Latino. Students completed the survey in all years of medical school. Research opportunities (H(2) = 18.58, P < .001) and having a race-concordant role model were the most important factors for those pursing OHNS residency. Personality fit and interactions with OHNS faculty had the greatest influence on their decision to pursue OHNS residency. Board scores (e.g., USMLE Step 1/2CK Scores), competitiveness, lifestyle during residency, the influence of application costs, and racial/ethnic and gender distributions did not reach statistical significance or were noninfluential.

CONCLUSION

URiMs applying to OHNS value race-concordant mentorship, are involved in research, and have meaningful relationships with their respective OHNS department. We found that establishing meaningful connections with URiM mentors significantly impacts URiM students considering OHNS. While this cohort was not influenced by overemphasis of board scores within the OHNS match process, the COVID-19 pandemic negatively impacted this aspect of their application, along with away rotations.

LEVEL OF EVIDENCE

NA Laryngoscope, 132:2335-2343, 2022.

Linguistic Biases in Letters of Recommendation for Radiation Oncology Residency Applicants from 2015 to 2019

We aimed to investigate whether implicit linguistic biases exist in letters of recommendation (LORs) for applicants to radiation oncology (RO) residency. LORs (n = 487) written for applicants (n = 125) invited to interview at a single RO residency program from the 2015 to 2019 application cycles were included for analysis. Linguistic Inquiry and Word Count (LIWC) software was used to evaluate LORs for length and a dictionary of predetermined themes. Language was evaluated for gender bias using a publicly available gender bias calculator. Non-parametric tests were used to compare linguistic domain scores. The median number of the LORs per applicant was 4 (range 3-5). No significant differences by applicant gender were detected in LIWC score domains or gender bias calculator (P > 0.05). However, LORs for applicants from racial/ethnic backgrounds underrepresented in medicine were less likely to include standout descriptors (P = 0.008). Male writers were less likely to describe applicant characteristics related to patient care (P < 0.0001) and agentic personality (P = 0.006). LORs written by RO were shorter (P < 0.0001) and included fewer standout descriptors (P = 0.014) but were also more likely to include statements regarding applicant desirability (P = 0.045) and research (P = 0.008). While language was globally male-biased, assistant professors were less likely than associate professors (P = 0.0064) and full professors (P = 0.023) to use male-biased language. Significant linguistic differences were observed in RO residency LORs, suggesting that implicit biases related to both applicants and letter writers may exist. Recognition, and ideally eradication, of such biases are crucial for fair and equitable evaluation of a diverse applicant pool of RO residency candidates.

Diversity, equity and inclusion: a survey of pediatric radiology fellowship graduates from 1996 to 2020

BACKGROUND

Understanding the sociodemographic diversity and the experiences of trainees is imperative for developing an inclusive pediatric radiology workforce and improving patient outcomes.

OBJECTIVE

To describe the sociodemographics of a pediatric radiology fellowship program over 25 years and examine potential associations with (a) a trainee's sense of inclusion and belonging during training and (b) graduates' ultimate choice/type of practice, progression to positions of leadership and mentorship of others.

MATERIALS AND METHODS

We designed and administered an online survey of sociodemographic diversity to graduates of one of the largest pediatric radiology fellowship programs in North America who graduated over the last 25 years. Respondents answered questions regarding (a) racial/ethnic identity, gender identity, sexual orientation, disability and other sociodemographics; (b) their sense of inclusion and belonging during fellowship training; and (c) their current type of practice, leadership and mentorship of others. Univariate analysis of variance (ANOVA) tests determined whether sociodemographic background was associated with inclusion/belonging during training, and with current type of radiology practice, leadership and mentorship. We assessed associations with covariates of interest and current leadership and mentorship roles using chi-square or Fisher exact tests. A heat map assessed individual and overall Likert scores across covariates.

RESULTS

Seventy-six graduates completed the survey (46% response rate). Three percent of respondents identified as Black/African American, 7% as Latino/a/x, 45% as female, 4% as LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) and 5% as living with a disability at the time of fellowship. Graduates of international medical schools (P = 0.09) and osteopathic medical (DO) schools (P = 0.09), first-generation college graduates (P = 0.023), those with a first language other than English (P = 0.02) and U.S. military veterans (P = 0.048) reported significantly lower feelings of inclusion and belonging during training. Gender identity and sexual orientation did not correlate with feelings of exclusion or inequity. Graduates between 1996 and 2010 were significantly more likely to have filled a leadership role than those graduating after 2011 (P = 0.004) and were also significantly more likely to have mentored individuals underrepresented in medicine/pediatric radiology than those who graduated after 2011 (P = 0.04). None of the other sociodemographic variables demonstrated an association with leadership or mentorship, although 92.3% of those with a first language other than English served as a mentor compared to 68.2% of native English speakers (P = 0.097).

CONCLUSION

Efforts to promote a more diverse and inclusive workforce in pediatric radiology should be directed toward increasing numbers of fellows who are underrepresented in medicine (Black/African American, Hispanic/Latino/a/x) and providing a more inclusive training environment for first-generation college graduates, graduates of international and DO medical schools, fellows whose first language is not English, and veterans of the U.S. Armed Forces.

Burnout, Mental Health, and Workplace Discrimination in Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, and Asexual Anesthesiologists

Increasing attention is being paid to both anesthesiologist well-being and commitments to diversity, equity, and inclusion. Sexual minorities (ie, members of the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual [LGBTQIA] communities) face many challenges in society and the workplace, including mental health conditions, discrimination, and increased risk for burnout. In this review, we outline the current state of mental health conditions and burnout in sexual minority individuals, discrimination and harassment faced both in society and the workplace, and steps that workplaces can take to become more inclusive and welcoming.

Creating a health equity and inclusion office in an academic pediatric medical center: priorities addressed and lessons learned

BACKGROUND

Over the last two decades, medical schools and academic health centers have acknowledged the persistence of health disparities in their patients and the lack of diversity in their faculty, leaders and extended workforce. We established an Office of Health Equity and Inclusion (OHEI) at our pediatric academic medical center after a thorough evaluation of prior diversity initiatives and review of faculty development data.

OBJECTIVE

To describe the lessons learned at a pediatric academic medical center in prioritizing and implementing health equity, diversity and inclusion (EDI) initiatives in creating the OHEI.

MATERIALS AND METHODS

We reviewed internal administrative data and faculty development data, including data related to faculty who are underrepresented in medicine, to understand the role of our EDI initiatives in the strategic priorities addressed and lessons learned in the creation of the OHEI.

RESULTS

The intentional steps taken in our medical center's strategic approach in the creation of this office led to four important lessons to improve pediatric health equity: (1) board, senior executive and institutional prioritization of EDI initiatives; (2) multi-specialty and interprofessional collaboration; (3) academic approach to EDI programmatic development; and (4) intentionality with accountability in all EDI initiatives.

CONCLUSION

The key lessons learned during the creation of an Office of Health Equity and Inclusion can provide guidance to other academic health centers committed to implementing institutional priorities that focus their EDI initiatives on the improvement of pediatric health equity.

Perceived Discrimination Among Surgical Residents at Academic Medical Centers

BACKGROUND

Residents of color experience microaggressions in the work environment, are less likely to feel that they fit into their training programs, and feel less comfortable asking for help. Discrimination has been documented among surgical residents, but has not been extensively studied and largely remains unaddressed. We sought to determine the extent of perceived discrimination among general surgery residents.

MATERIALS AND METHODS

Residents who were enrolled in a randomized controlled trial investigating a cultural dexterity curriculum completed baseline assessments prior to randomization that included demographic information and the Everyday Discrimination Scale (EDS). Data from the baseline assessments were analyzed for associations of EDS scores with race, ethnicity, sex, socioeconomic level, language ability, and training level.

RESULTS

Of 266 residents across seven residency programs, 145 (55%) were men. Racial breakdown was 157 (59%) White, 45 (17%) Asian, 30 (11%) Black, and 12 (5%) Multiracial. The median EDS score was seven (range: 0-36); 58 (22%) fell into the High EDS score group. Resident race, fluency in a language other than English, and median household income were significantly associated with EDS scores. When controlling for other sociodemographic factors, Black residents were 4.2 (95% CI 1.62-11.01, P = 0.003) times as likely to have High EDS scores than their White counterparts.

CONCLUSIONS

Black surgical residents experience high levels of perceived discrimination on a daily basis. Institutional leaders should be aware of these findings as they seek to cultivate a diverse surgical training environment.

Understanding and finding opportunities for inclusive mentorship and sponsorships in vascular surgery

Deliberate efforts are needed to address the lack of diversity in the vascular surgery workforce and to correct the current scarcity of diversity in vascular surgery leadership. Effective mentorship and sponsorship are crucial for success in academic surgery. In the present report, we have explained the importance of mentorship and sponsorship relationships for surgeons historically underrepresented in medicine, discussed the unique challenges faced by them in academic surgery, and provided a practical framework for fostering intentional and thoughtful mentor and sponsor relationships to nurture their careers.

Mentoring Residents Underrepresented in Medicine: Strategies to Ensure Success

OBJECTIVE

To provide a framework for effective mentorship of residents underrepresented in medicine (UIM) situated in the context of their experiences in healthcare teams.

DESIGN

A perspective summarizing the important elements for the effective mentorship of UIM residents.

CONCLUSION

Mentorship of trainees is of profound importance in medical education as it provides tangible benefits for professional and personal development. However, given their unique experiences and position in our teams as well as the larger healthcare construct, the mentorship of UIM residents requires special consideration and focus. Implementing programs that foster diversity, cross-cultural mentorship, and sponsorship are imperative.

Who We Are Today: a National Survey of Diversity Among Psychiatry Program Directors

OBJECTIVE

In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee's goals was to understand the AADPRT membership's composition and their perceptions of D&I. This study's objective was to identify the demographic characteristics of the AADPRT membership.

METHODS

Program directors were invited by email to participate in an anonymous survey. The survey collected participants' demographic information including gender, race/ethnicity, training background, age, disability/differently abled status, job role, geographic region where their program is located, type of program, and their program's community setting.

RESULTS

Two hundred fifty six of 657 AADPRT members (39%) completed the survey. Respondents were mostly White (64.5%) followed by Asian/Southeast Asian (17.6%), Hispanic/Latinx (4.3%), and Black (1.6%). Only 13.3% of the participants were international medical graduates. Women were more prevalent (61.7%) than men (37.5%), and 9.4% self-identified as members of the LGBTQ+ Community.

CONCLUSIONS

This study represents the first systematic investigation into the diversity among psychiatry program directors throughout the USA and Canada. Future qualitative studies are needed to better understand the reasons behind this initial study's findings. Potential concerns requiring exploration include the possibility of the program director role serving as a "glass ceiling" for some women and a "leaky pipeline" in academia for groups underrepresented in medicine.

Current and Historical Trends in Diversity by Race, Ethnicity, and Sex Within the US Pathology Physician Workforce

OBJECTIVES

This study assessed historical and current gender, racial, and ethnic diversity trends within US pathology graduate medical education (GME) and the pathologist workforce.

METHODS

Data from online, publicly available sources were assessed for significant differences in racial, ethnic, and sex distribution in pathology trainees, as well as pathologists in practice or on faculty, separately compared with the US population and then each other using binomial tests.

RESULTS

Since 1995, female pathology resident representation has been increasing at a rate of 0.45% per year (95% confidence interval [CI], 0.29-0.61; P < .01), with pathology now having significantly more females (49.8%) compared to the total GME pool (45.4%; P < .0001). In contrast, there was no significant trend in the rate of change per year in black or American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander (AI/AN/NH/PI) resident representation (P = .04 and .02). Since 1995, underrepresented minority (URM) faculty representation has increased by 0.03% per year (95% CI, 0.024-0.036; P < .01), with 7.6% URM faculty in 2018 (5.2% Hispanic, 2.2% black, 0.2% AI/AN/NH/PI).

CONCLUSIONS

This assessment of pathology trainee and physician workforce diversity highlights significant improvements in achieving trainee gender parity. However, there are persistent disparities in URM representation, with significant underrepresentation of URM pathologists compared with residents.

Factors that Influence Underrepresented in Medicine (UIM) Medical Students to Pursue a Career in Academic Pediatrics

PURPOSE

The purpose of this study was to explore the experiences of medical students who are underrepresented in medicine (UIM) from two urban medical centers with an interest in pursuing academic pediatrics.

METHODS

Focus groups were conducted at Children's National Hospital (CN) at three different times with UIM medical students from two urban medical centers. The investigator team was comprised of both junior and senior UIM and non-UIM pediatric academic faculty with experience in qualitative research. Twenty medical students UIM from Howard University College of Medicine (HUCM) and George Washington University School of Medicine and Health Sciences (GWSMHS) participated in the focus groups. The medical students targeted were first, second and fourth years to review experiences pre-and post-third year clerkships.

RESULTS

Eighteen of the 20 students completed the demographic data of which 16 identified as Black/African-American. Fifteen of the participants were female and 3 were male. Findings indicated that mentorship, serving as role models, working with children and seeing UIM academic pediatricians positively influenced the students to pursue academic pediatrics. Family had a major influence on students' interest to pursue medicine. A barrier to pursuing academic pediatrics for UIM medical students included educational debt and lack of knowledge about the field. The students felt that there were fewer expectations of them during secondary school years which affected them throughout their journey to medical school.

CONCLUSIONS

Early mentorship for UIM medical students is important to increase exposure to academic pediatrics. Future study on the experience of UIM medical students and their pursuit of academic roles could help produce a more diverse workforce. Also, pipeline programs for students to be exposed to academic pediatrics early in their education career would be beneficial.

Diversity and Inclusion-Why Does It Matter

Otolaryngology has historically lagged behind other specialties with respect to diversity, equity and inclusion (DEI) and remains one of the least diverse specialties as it relates to gender, race and ethnicity. Strategies aimed at increasing DEI include programs designed to provide mentorship, coaching, and sponsorship. Pipeline efforts, inclusivity on committees, bi-directional communication, and equal pay are additional DEI efforts that have been successful in recruiting and retaining those under-represented in medicine (URiM). Closing the equity gap requires commitment; daily action and measuring progress is required. Finally, use feedback to make refinements as opportunities exist to continually improve DEI efforts.

Alignment of roles of near-peer mentors for medical students underrepresented in medicine with medical education competencies: a qualitative study

BACKGROUND

Medical student learning experiences should facilitate progressive development of competencies required for practice. Medical school training opportunities have traditionally focused on acquiring medical knowledge and patient care competencies while affording less opportunity to receive feedback on practice-based improvement and system-based practice competencies. The Prematriculation program at the University of Minnesota Medical School Duluth Campus (UM MSD) utilized near-peer mentors to support the transition of students underrepresented in medicine, including American Indian/ Alaska Natives (AI/AN) and those from rural backgrounds, into medical school. The purpose of this study is to better define the role of near-peer mentors and explore the alignment of near-peer mentorship with the ACGME core competencies.

METHODS

An important component of the Prematriculation program, designed to prepare incoming under-represented students for medical school, was the inclusion of near-peer mentors. The six near-peer mentors participated in semi-structured interviews or focus groups within 1 year of serving as a near-peer mentor. Themes emerged from open-coding of the transcripts.

RESULTS

The near-peer mentors drew on their own experiences to transmit information that supported the socialization of the matriculating students into medical school. Direct benefits to the mentors included solidifying their own understanding of medical knowledge and execution of procedural skills. Mentors provided examples of benefits related to their own development of interpersonal communication and professionalism skills. Operating in the context of the program provided opportunities to engage mentors in practice-based improvement and system-based practice.

CONCLUSIONS

Serving as a near-peer mentor offers significant benefits to medical students from backgrounds underrepresented in medicine. By taking on the peer mentoring leadership role, students progressed toward the competencies required of an effective physician. Given the importance of acquiring these competencies, it is worth considering how near-peer mentoring can be applied more broadly across the medical school curriculum.

Value of Near-Peer Mentorship from Protégé and Mentor Perspectives: A Strategy to Increase Physician Workforce Diversity

PURPOSE

Mentorship is a critical aspect of personal and professional development in academic medicine and helps to improve career satisfaction, productivity, and social networking. However, individuals from communities underrepresented in medicine (URiM) across the training continuum experience difficulty obtaining mentors, even prior to college. The value of near-peer mentorship is less well studied in medicine relative to other fields. The purpose of this mixed methods study is to explore the mentorship experiences of high school student protégés and their medical student mentors, as well as provide a description of the key features of the Doctors of Tomorrow (DOT) program.

METHODS

From November 2014 to September 2015, the authors used focus groups and critical incident narratives with 9th grade high school students as well as focus groups and semi-structured interviews with medical students to examine mentor-protégé experiences in the Doctors of Tomorrow (DOT) program. In 2016, thirty-one medical student mentors were asked to complete an online survey about their mentor experiences. Focus group and interview data were audio-recorded and transcribed verbatim. All data were coded using thematic analysis and recurring codes were organized into categories, then compared, scrutinized and arranged into broader themes by all authors.

RESULTS

The analysis of data from 70 medical students and 52 high school students revealed that mentors and protégés valued their mentor relationships based on regular in-person and electronic contact, shared common non-academic interests, and the anticipated prolonged nature of the relationship. Mentors also reported they initiated contact with their protégés every 2-3 weeks and monthly outside of program events, with email communication as the most common modality.

CONCLUSIONS

Near-peer relationships between high school and medical students may be an innovative strategy to promote health care careers, increase access to mentorship and develop meaningful mentorship relationships for URiM high school students.