Matching Our Mission: A Strategic Plan to Create a Diverse Family Medicine Residency

Race, Ethnicity, and Sex Representation Trends among Minimally Invasive Gynecologic Surgery Fellowship Trainees and Graduates

STUDY OBJECTIVE

To study the race, ethnicity, and sex representation and annual trends of AAGL FMIGS fellows and graduates.

DESIGN

A retrospective cross-sectional study.

SETTING

AAMC databases were queried for demographic information between 2011 - 2023.

PATIENTS/SUBJECTS

AAGL FMIGS fellows and graduates.

INTERVENTIONS

N/A MEASUREMENTS AND MAIN RESULTS: Descriptive statistical analysis and the actual-to-expected (AE) ratio of each race, ethnicity, and sex were performed. AE ratio was calculated by dividing the 13-year average actual percentage of FMIGS trainees and graduates by the expected percentage based demographics of OBGYN residents and the US general population. 477 fellows graduated or were in training between 2011 and 2023; race and ethnicity information was obtained for 347 (72.7%) individuals, and sex information was available for 409 (85.7%). Representation of females ranged from 66.7% in 2017 to 93.3% in 2022. There was a significantly increasing slope for the representation of females (+1.3% per year; 95% CI 0.00-0.03; p=0.027). Compared to their distribution among US OBGYN residents, White fellows' representation was lower [AE ratio, 95% CI 0.60 (0.44-0.81)] and of Asian fellows was higher [AE ratio, 95% CI 2.17 (1.47-3.21)]. Female fellows' representation was lower than expected [AE ratio, 95% CI 0.68 (0.48-0.96)] compared to their distribution among US OBGYN residents. Compared to the general US population, White fellows [AE ratio, 95% CI 0.65 (0.48-0.87)] and Hispanic fellows [AE ratio, 95% CI 0.53 (0.34-0.83)] representation was lower. Asian fellows' representation was higher compared to the general US population [AE ratio, 95% CI 5.87 (3.48-9.88)].

CONCLUSION

White and Hispanic fellows' representation was lower than expected, while Asian fellows' representation was higher in AAGL-accredited FMIGS programs. Female representation increased throughout the years, but overall, female fellows' representation was lower than expected compared to their distribution among OBGYN residents. These findings may help develop equitable recruitment strategies for FMIGS programs and reduce health disparities within complex gynecology.

Towards inclusive learning environments in post-graduate medical education: stakeholder-driven strategies in Dutch GP-specialty training

BACKGROUND

A recent study found that ethnic minority General Practice (GP)-trainees receive more negative assessments than their majority peers. Previous qualitative research suggested that learning climate-related factors play a pivotal role in unequal opportunities for trainees in post-graduate medical settings, indicating that insufficient inclusivity had put minority students at risk of failure and dropout.

STUDY OBJECTIVES

We aimed to develop broadly supported strategies for an inclusive learning climate in Dutch GP-specialty training.

METHODS

We employed Participatory Action Research (PAR)-methods, incorporating Participatory Learning and Action (PLA)-techniques to ensure equal voices for all stakeholders in shaping Diversity, Equity, and Inclusion (DEI)-strategies for GP-specialty training. Our approach engaged stakeholders within two pilot GP-specialty training institutes across diverse roles, including management, support staff, in-faculty teachers, in-clinic supervisors, and trainees, representing ethnic minorities and the majority population. Purposeful convenience sampling formed stakeholder- and co-reader groups in two Dutch GP-specialty training institutes. Stakeholder discussion sessions were based on experiences and literature, including two relevant frameworks, and explored perspectives on the dynamics of potential ethnic minority trainees' disadvantages and opportunities for inclusive strategies. A co-reader group commented on discussion outcomes. Consequently, a management group prioritized suggested strategies based on expected feasibility and compatibility.

RESULTS

Input from twelve stakeholder group sessions and thirteen co-readers led to implementation guidance for seven inclusive learning environment strategies, of which the management group prioritized three: • Provide DEI-relevant training programs to all GP-specialty training stakeholders; • Appoint DEI ambassadors in all layers of GP-specialty training; • Give a significant voice to minority GP-trainees in their education.

CONCLUSION

The study's participatory approach engaged representatives of all GP-specialty training stakeholders and identified seven inclusive learning climate strategies, of which three were prioritized for implementation in two training institutions.

Recommendations for Improvement of Equity, Diversity, and Inclusion in the CaRMs Selection Process

Equity, diversity and inclusion (EDI) in the medical field is crucial for meeting the healthcare needs of a progressively diverse society. A diverse physician workforce enables culturally sensitive care, promotes health equity, and enhances the comprehension of the various needs and viewpoints of patients, ultimately resulting in more effective treatments and improved patient outcomes. However, despite the recognized benefits of diversity in the medical field, certain specialties, such as Radiology, have struggled to achieve adequate equity, diversity and inclusion, which results in a discrepancy in the demographics of Canadian radiologists and the patients we serve. In this review, we propose strategies from a committee within the Canadian Association of Radiologists (CAR) EDI working group to improve EDI in the CaRMS selection process. By adopting these strategies, residency programs can foster a more diverse and inclusive environment that is better positioned to address the health needs of a progressively diverse patient population, leading to improved patient outcomes, greater patient satisfaction, and advancements in medical innovation.

Enhancing Medical Spanish Education and Proficiency to Bridge Healthcare Disparities: A Comprehensive Assessment and Call to Action

This article highlights the critical importance of linguistic and cultural concordance in health care, particularly in addressing the shortage of proficient Spanish-speaking healthcare providers in California. It advocates for standardized curricula, qualified instructors, and mandatory medical Spanish courses while stressing the significance of interdisciplinary training that integrates language skills with clinical experience and acknowledges the interplay between language and culture in health care. The article calls for proactive efforts from medical schools, faculty, and healthcare providers, emphasizing standardized curricula, culturally sensitive training, and reliable assessment tools. Additionally, it underscores the need to enhance the representation of underrepresented minority healthcare providers to ensure equitable health care for linguistic minorities, emphasizing the shared responsibility of healthcare and education stakeholders.

Addressing diversity in the physician workforce through social determinants of medical education

Social determinants of medical education are the most impactful aspects of recruiting, retaining, and producing the next generation of a diverse physician workforce. We can use the same framework well known to describe social determinants of health to identify social determinants that impact medical education learners and their ability to enter the workforce and succeed to completion. Efforts aimed at recruitment and retention should not exist in isolation and must be matched with those that continuously assess and evaluate the learning environment. The development of a climate where all can bring their full selves to learn, study, work, and care for patients is critically important in the creation of a learning environment where every participant can grow and thrive. If we are to address the need to diversify the workforce, we must be intentional with strategic plans, which includes addressing the social determinants that are prohibitive for some of our learners.

A Cross-Sectional Descriptive Analysis of Diversity, Equity, and Inclusion Presence Among United States Occupational and Environmental Medicine Residency Program Websites

OBJECTIVE

To evaluate the presence of diversity, equity, and inclusion (DEI) among US occupational and environmental medicine (OEM) residency program websites.

METHODS

In January to February 2022, two independent reviewers evaluated the websites of all 24 US accredited OEM residency programs and documented the presence of 10 predetermined DEI metrics and resident/faculty photographs and biographies.

RESULTS

Program websites included a median of 1 (0-3) DEI element with 46% of websites containing none of the DEI metrics. Faculty photographs and biographies were included in 83% and 75% of websites, respectively. Resident photographs and biographies were included in 50% and 25% of websites, respectively.

CONCLUSIONS

Many OEM residency program websites lack DEI presence. Programs should consider presenting information relevant to DEI on their websites to help attract more diverse applicant pools.

Interventions Associated With Racial and Ethnic Diversity in US Graduate Medical Education: A Scoping Review

IMPORTANCE

Racially and ethnically minoritized individuals remain underrepresented in graduate medical education relative to their proportion in the population. While many programs and initiatives have been developed to address this problem, there is little consensus regarding strategies that work to improve representation across specialties.

OBJECTIVE

To examine and synthesize evidence-based practices that have been used to increase the proportions of underrepresented in medicine (URiM) trainees at US residency and fellowship programs.

EVIDENCE REVIEW

The authors searched PubMed, Google Scholar, Embase, PsycInfo, ERIC, Cochrane Reviews, Cochrane Trials, CINAHL, Scopus, and PROSPERO electronic databases to identify relevant studies published through January 2022. They screened all titles and abstracts for relevance and read full-text articles to identify articles reporting reliable data describing the outcomes of interventions to improve racial and ethnic diversity among trainees.

FINDINGS

Twenty-seven articles were included in this review. Two studies reported on fellowship programs. The most common interventions included holistic review (48%), decreased emphasis on United States Medical Licensing Examination Step 1 scores (48%), and explicit institutional messaging regarding the importance of diversity (37%). A combination of interventions was associated with an increased number of URiM applicants, interviewees, and matriculants across various medical and surgical specialties.

CONCLUSIONS AND RELEVANCE

In this scoping review, approaches and interventions associated with increased diversity in residency and fellowship programs were identified. Continued efforts are necessary to sustain such efforts and assess long-term outcomes.

Equity Rx: Boston Medical Center's Work to Accelerate Racial Health Justice

In November 2021, after more than a year of investigating the racial health disparities across its organization, Boston Medical Center launched the Health Equity Accelerator, a system-wide approach to holistically address the root causes of health inequities among people of different races and ethnicities and speed improvements in health outcomes. This article discusses lessons learned during the institution's process of discovery, shares examples of the work to dismantle a structural narrative that impedes health justice, and outlines interventions that can be applied to other healthcare systems across the United States.

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

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

Implementing a “Distance Traveled” Question to Improve Resident Diversity: Process and Feasibility

Increasing diversity in the physician workforce is important to improving racial and ethnic disparities in health outcomes in the United States. We describe the implementation of a “distance traveled” question (DTQ) in our residency application process. For the 2021-2022 cycle, all applicants to the University of Washington otolaryngology residency program were allowed to complete an optional DTQ. Responses were shared with the application review committee. Following the distribution of interview invites, an anonymous survey was sent to all faculty reviewers. The response rate was 26 of 36 (72%). Among respondents, 20 (77%) felt that the DTQ helped them learn something new about the applicant, and 19 (73%) reported that the DTQ influenced their decision making about the applicant. Thus, a DTQ may provide faculty with new and influential information regarding residency applicants.

Racial and Ethnic Diversity Within U.S. Residencies: Trends from 2011 to 2019

OBJECTIVE

Examine trends in the proportion of underrepresented minority (URM) residents from 2011 to 2019 across all specialties and investigate differences between surgical and non-surgical specialties.

DESIGN

Cross-sectional study.

SETTING

N/A.

PARTICIPANTS

The authors extracted data on the proportion of URM residents in all specialties from the Accreditation Council for Graduate Medical Education yearly reports.

RESULTS

There was a statistically significant decline in the proportion of URM residents in surgical specialties (p < 0.01) from 2011 (9.9%) to 2019 (9.1%) and a significant increase in the proportion of URM residents in non-surgical specialties (p < 0.01) from 2011 (9.6%) to 2019 (10.2%).

CONCLUSIONS

This study emphasizes the need to increase recruitment of URMs in medicine, especially in surgical specialties. Findings from this study can inform much-needed initiatives to address barriers to entry for diverse applicants within specialties that lack diversity and have shown minimal improvement over time.

Do Orthopedic Surgery Residency Program Web Sites Address Diversity and Inclusion?

Background

Orthopedic surgery is one of the least diverse medical specialties. Other medical specialties have employed diversity-related initiatives to increase the number of students underrepresented in medicine (URM). Furthermore, with the suspension of visiting student rotations during the COVID-19 pandemic, medical students used residency program Web sites as a main source of program-specific information.

Aims/Purpose

The purpose of this study was to measure the extent to which orthopedic surgery residency program Web sites describe diversity and inclusion initiatives.

Methods

The Electronic Residency Application Service (ERAS) was used to identify U.S. orthopedic surgery residency programs. The programs' Web sites were reviewed, and data on commitments to diversity and inclusion were collected. Descriptive statistics of these data were generated.

Results

There were 192 residency programs identified and 3 were excluded from the analysis due to lack of Web sites. Of the remaining 189 residency program Web sites, only 55 (29.10%) contained information on diversity and inclusion. Information on a commitment to improving diversity and inclusion was the most prevalent data point found among program Web sites, although it was found on only 15% of program Web sites.

Conclusion

Orthopedic surgery residency programs rarely address topics related to diversity and inclusion on their program Web sites. An emphasis on opportunities for URM students and initiatives related to diversity and inclusion on program Web sites may improve URM outreach and serve as one method for increasing URM matriculation into orthopedic surgery.

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

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

Diversity, Equity, and Inclusion Milestones: Creation of a Tool to Evaluate Graduate Medical Education Programs

BACKGROUND

As the Accreditation Council for Graduate Medical Education (ACGME) began to ask programs to report their efforts surrounding diversity, equity, and inclusion (DEI), program directors felt ill prepared to evaluate their programs and measure change.

OBJECTIVE

To develop a tool that would allow graduate medical education (GME) programs to evaluate the current state of DEI within their residencies, identify areas of need, and track progress; to evaluate feasibility of using this assessment method within family medicine training programs; and to analyze and report pilot data from implementation of these milestones within family medicine residency programs.

METHODS

The Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed a tool for program DEI evaluation modeled after the ACGME Milestones. These milestones focus on DEI assessment in 5 key domains: Institution, Curriculum, Evaluation, Resident Personnel, and Faculty Personnel. After finalizing a draft, a pilot implementation of the milestones was conducted by a convenience sample of 10 AFMRD DHE Task Force members for their own programs.

RESULTS

Scores varied widely across surveyed programs for all milestones. Highest average scores were seen for the Curriculum milestone (2.65) and the lowest for the Faculty Personnel milestone (2.0). Milestone assessments were completed within 10 to 40 minutes using various methods.

CONCLUSIONS

The AFMRD DEI Milestones were developed for program assessment, goal setting, and tracking of progress related to DEI within residency programs. The pilot implementation showed these milestones were easily used by family medicine faculty members in diverse settings.

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.

Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education

Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

Increasing URiM Family Medicine Residents at University of Utah Health

INTRODUCTION

The Department of Family and Preventive Medicine is home for the University of Utah's Family Medicine Residency program. Although Utah's diversity is steadily increasing, the race/ethnic diversity of the program's family medicine residency does not reflect the state's general population.

METHODS

From 2017 to 2021, the residency instituted several adjustments to recruitment processes, including modification of an existing screening system to better highlight resiliency in overcoming challenging life experiences; promotion of commitment to diversity during interview days; incorporation of increased participation from diverse faculty and residents on interview days; and addition of outreach from the Office of Health, Equity, Diversity, and Inclusion. Underrepresented in medicine (URiM) applicants were the first to be offered interviews in an identical screening score cohort, and were ranked highest in rank lists in cohorts with identical final rank scores.

RESULTS

Over the past five match cycles, Latinx residents have increased from zero to six, and underrepresented Asian residents from zero to two. In the 2021 match cycle, five of 10 incoming residents (50%) are URiM. Overall, URiM residents are now 30%, and residents of color 36%, of a total of 30 residents across all 3 training years. We found that eight URiM interviews were needed for every one URiM match.

CONCLUSION

Intentional resident recruitment initiatives can transform racial/ethnic diversity in a family medicine residency program in a short amount of time.

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.

Racism and persistent disparities: Difficult conversations on the road to equity

The convergence of the major social events of the COVID 19 epidemic and the racial protests around the George Floyd killing spurred many conversations and calls to action for racial justice. The Behavioral Science Forum of 2020 invited a plenary presentation to discuss guidelines for medical education institutions to improve their anti-racism curricula. The plenary aimed to put forward the personal experiences of family medicine faculty contributing to dismantling racism in their institutions. Presenters provided (1) a breakdown of the step by step process of addressing these issues with faculty, residents, and staff, (2) guidelines for improving recruitment and retention of diverse student populations, and (3) small group breakouts and a subsequent discussion forum for participants to bring their experiences into the conversation and develop their personal call to action. The wrap-up discussion and "Zoom chat" yielded emotional responses and specific ideas for participants and other faculty in medical education to do their part in developing anti-racism curricula.

Engage me: Will residency program directors listen?

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The implementation of multi-level modifications, including but not limited to outreach initiatives and the development of a holistic application review approach, are potential strategies to improve diversity and inclusivity in general surgery residency recruitment.

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We encourage program directors to invest in trainees' success and implement human capital changes that produce sustinable and effective changes, and help in building the pipeline.

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Program directors are encouraged to work with their institutions to develop a holistic review approach through the following initiatives: recruitment of an inclusive and diverse interview selection committee, implementation of implicit bias training among all faculty and residents participating in the selection process, and promotion of structured interviews that focus on applicant characteristics that resonate with the program's mission statement.

Avoiding the Virtual Pitfall: Identifying and Mitigating Biases in Graduate Medical Education Videoconference Interviews

Public health concerns related to the COVID-19 pandemic are leading many residency and fellowship programs to transition from in-person to videoconference interviews (VCIs). The magnitude and speed of the shift to VCIs, the lack of existing research around bias and VCIs, and the underlying stress on all involved related to the pandemic put programs at risk of implementing virtual interviews without fully exploring their implications for diversity and equity. VCIs can promote diversity efforts by reducing the need for travel, making interviews more convenient and cost effective for applicants. However, VCIs may also introduce new biases and amplify existing biases in recruitment. VCIs introduce a dependence on technology to conduct the interview process, which may amplify systemic inequities in access to broadband internet and high-quality hardware. Communication delays due to technology challenges may negatively affect interview scores. Additionally, users experience increased cognitive load when participating in videoconferences, which can activate implicit biases. Exposure to cues in the interviewee's personal living situation previously unavailable to interviewers may lead to unconscious assumptions by interviewers, which may also influence scoring. Graduate medical education programs committed to maintaining equitable recruitment processes must be able to recognize potential biases in VCIs and implement strategies to mitigate them. This article identifies some of the biases VCIs can introduce to the recruitment process and offers strategies for programs to mitigate them. These include making interviewers aware of potential technology-based inequities, encouraging interviewers to minimize multitasking, and offering guidance on use of standardized backgrounds. The authors also recognize the limitations of offering behavioral strategies to mitigate systemic inequities and suggest that structural changes are needed to ensure equitable access to technology.

The Feasibility of Blinding Residency Programs to USMLE Step 1 Scores During GME Application, Interview, and Match Processes

BACKGROUND

With the recent announcement that Step 1 score reporting will soon change to pass/fail, residency programs will need to reconsider their recruitment processes.

OBJECTIVE

We (1) evaluated the feasibility of blinding residency programs to applicants' Step 1 scores and their number of attempts throughout the recruitment process; (2) described the selection process that resulted from the blinding; and (3) reviewed if a program's initial rank list, created before scores were known, would be changed before submission for the Match.

METHODS

During the 2018-2019 and 2019-2020 recruitment seasons, all programs at a single sponsoring institution were invited to develop selection criteria in the absence of Step 1 data, and to remain blinded to this data throughout recruitment. Participating programs were surveyed to determine factors affecting feasibility and metrics used for residency selection. Once unblinded to Step 1 scores, programs had the option to change their initial rank lists.

RESULTS

Of 24 residency programs, 4 participated (17%) in the first year: emergency medicine, neurology, pediatrics, and psychiatry. The second year had the same participants, with the addition of family and community medicine and radiation oncology (n = 6, 25%). Each program was able to determine mission-specific qualities in the absence of Step 1 data. In both years, one program made changes to the final rank list.

CONCLUSIONS

It was feasible for programs to establish metrics for residency recruitment in the absence of Step 1 data, and most programs made no changes to final rank lists after Step 1 scores were known.

Underrepresented minority representation trends in gynecologic oncology fellowships in the United States

OBJECTIVE

To evaluate representation trends of historically underrepresented minority (URM) groups in gynecologic oncology fellowships in the United States using a nationwide database collected by the Accreditation Council for Graduate Medical Education (ACGME).

METHODS

Data on self-reported ethnicity/race of filled residency positions was collected from ACGME Database Books across three academic years from 2016 to 2019. Primary chi-square analysis compared URM representation in gynecologic oncology to obstetrics and gynecology, other surgical specialties, and other medical specialties. Secondary analysis examined representation of two URM subgroups: 1) Asian/Pacific Islander, and 2) Hispanic, Black, Native American, Other (HBNO), across specialty groups.

RESULTS

A total of 528 gynecologic oncology positions, 12,559 obstetrics and gynecology positions, 52,733 other surgical positions, and 240,690 other medical positions from ACGME accredited medical specialties were included in analysis. Primary comparative analysis showed a statistically significant lower proportion (P < 0.05) of URM trainees in gynecologic oncology in comparison to each of obstetrics and gynecology, other surgical fields, and other medical fields. Secondary analysis also demonstrated a significantly lower proportion (P < 0.05) of HBNO physicians in gynecologic oncology in comparison to obstetrics and gynecology, as well as all other medical and surgical specialties.

CONCLUSIONS

This study illustrates the disparities in URM representation, especially those who identify as HBNO, in gynecologic oncology fellowship training in comparison to obstetrics and gynecology as well as other medical and surgical fields. Improvements to the current recruitment and selection practices in gynecologic oncology fellowships in the United States are necessary in order to ensure a diverse and representative workforce.

Analysis of Electronic Residency Application Service (ERAS) Data Can Improve House Staff Diversity

BACKGROUND

Training diverse house staff, including those who are underrepresented in medicine, is vital to provide high-quality patient care for the communities that we serve. In 2018, the Accreditation Council for Graduate Medical Education announced new common program requirements for systematic efforts to recruit and retain a diverse workforce. However, questions remain about how to implement such efforts.

MATERIALS AND METHODS

Electronic Residency Application Service (ERAS) data from eight residency programs spanning two recruitment cycles (2017-2018, 2018-2019) was reviewed. The number of candidates at each stage in the process (applicant, invited to interview, interviewed, and matched) was examined by self-identified race or ethnicity. These data were presented to residency program directors at our Graduate Medical Education committee meeting before the next recruitment cycle. Data were analyzed following the 2019-20 residency match. Odds ratios and Pearson's chi-squared test were used to assess statistical significance.

RESULTS

A total of 10,445 and 10,982 medical students applied to our 8 core residency programs in 2017 and 2018, respectively. Medical students who applied and self-identified as Asian, Black or African American, and Hispanic or Latino or Spanish origin had lower odds of being invited to interview than those who self-identified as White. After data presentation, the odds of inviting Black or African American applicants to interview increased significantly. The odds of attending an interview once invited were the same across groups.

CONCLUSIONS

Sharing ERAS data patterns with residency program directors was associated with a significant year over year change in interviewee diversity. Structured analysis of institutional ERAS data can provide insight into the resident selection process and may be a useful tool to improve house staff diversity.

Membership Trends in the Academic Pediatric Association From 2009 to 2018

OBJECTIVE

To describe changes in the racial and ethnic diversity of the membership of a national academic health professional organization, the Academic Pediatric Association (APA) from 2009 to 2018.

METHODS

Administrative data from the APA was used for the study. Our sample was limited to dues-paying members of the APA with complete profile information. Data on race/ethnicity was collected by self-report and categorized as White, Hispanic, Black, Asian, or other. Gender was obtained by self-report (male/female). Membership type included physician, non-physician, or trainee and was provided by self-report. Age was calculated by subtracting the dues year from the year of birth. Descriptive statistics were used. Log-linear models were used to describe changes in membership race/ethnicity and expressed as relative risk.

RESULTS

Three thousand one hundred and ninety-six unique individuals were included. Enrollment in the APA increased from 1429 in 2009 to 1803 in 2018. Females represented 68% of the sample. Six percent of the sample identified as Black, 5% as Hispanic, 12% as Asian, and 74% as White. Using log-linear models, the proportion of members identifying as Black increased from 4% to 6% (P < .001), Asian 8% to 13% (P < .001) and Hispanic increased 4% to 5% (P = .17).

CONCLUSIONS

The APA has increased the representation of underrepresented racial and ethnic minorities in medicine within its membership. The APA and other academic pediatric professional organizations, can build on these current trends by continuing to invest in programming focused on increasing racial/ethnic minority groups underrepresented in medicine.

A Framework for Inclusive Graduate Medical Education Recruitment Strategies: Meeting the ACGME Standard for a Diverse and Inclusive Workforce

To help address health care disparities and promote higher-quality, culturally sensitive care in the United States, the Accreditation Council for Graduate Medical Education and other governing bodies propose cultivating a more diverse physician workforce. In addition, improved training and patient outcomes have been demonstrated for diverse care teams. However, prioritizing graduate medical education (GME) diversity and inclusion efforts can be challenging and unidimensional diversity initiatives typically result in failure.Little literature exists regarding actionable steps to promote diversity in GME. Building on existing literature and the authors' experiences at different institutions, the authors propose a 5-point inclusive recruitment framework for diversifying GME training programs. This article details each of the 5 steps of the framework, which begins with strong institutional support by setting diversity as a priority. Forming a cycle, the other 4 steps are seeking out candidates, implementing inclusive recruitment practices, investing in trainee success, and building the pipeline. Practical strategies for each step and recommendations for measurable outcomes for continued support for this work are provided. The proposed framework may better equip colleagues and leaders in academic medicine to prioritize and effectively promote diversity and inclusion in GME at their respective institutions.

Diversity in the Pulmonary and Critical Care Medicine Pipeline. Trends in Gender, Race, and Ethnicity among Applicants and Fellows

Background: The diversity in pulmonary and critical care medicine (PCCM) training programs in the United States has not been systematically evaluated, despite emphasis on workforce diversity and its role in improving gender and racial healthcare disparities.

Objectives: We analyzed the diversity of the PCCM pipeline by gender, race, and ethnicity over the last 10 years.

Methods: The PCCM pipeline was defined as internal medicine residents, fellowship applicants, and fellows in pulmonary-only, critical care medicine–only, and combined PCCM programs. Data on gender, race, and ethnicity were obtained from 2009 to 2018 graduate medical education census data and the Association of American Medical Colleges Electronic Resident Application Service. We used the Association of American Medical Colleges definition of “underrepresented in medicine” (UIM), which comprises African American/black, Hispanic/Latino, American Indian/Alaska Native, or Native Hawaiian/Pacific Islander physicians.

Results: Over the last decade, the percentage of female fellows was unchanged in pulmonary (range, 19.4–37.1%), critical care medicine (range, 17.6–31.9%), and PCCM programs (range, 29.5–35.2%). To capture the current snapshot of data across residents, applicants, and fellows, we analyzed 2018 data and found that there was a drop-off from the percentage of female internal medicine residents (41.9%) to the percentage of female applicants and fellows (⩽33% in all three programs). The percentage of UIM fellows decreased in PCCM programs over the last decade to 10.3%. In 2018, there was a drop-off from the percentage of UIM residents (13.7%) to the percentage of UIM fellows in all three programs (<12.9% in all three programs).

Conclusions: Striking disparities remain in gender, race, and ethnicity in the pipeline of trainees in PCCM programs; these have not improved (for gender) or have even worsened (for race and ethnicity) over the last decade.

The Robert Wood Johnson Nurse Faculty Scholars Diversity and Inclusion Research

Purpose: The purpose of this research is to deepen the understanding of DEI training and show how scholars across the nation incorporated DEI leadership into academic roles. Faculty and administrators' experiential experience in diversity, equity, and inclusion (DEI) plays a role in the success or failure of DEI training. DEI training at institutes of higher learning should include metrics that examine our bias for invisible and overt support for DEI.

Methods: Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJFNFS) were surveyed by The Gauda Group at Grayling. Data were collected from a diverse group of scholars across the nation. An online survey followed by an in-depth phone interview was used to assess participants' roles as leaders in academic nursing, challenges faced by scholars in addressing DEI, and perceived values of undertaking DEI activities.

Results: Major themes emerged from the findings. The themes included championing for DEI comes with a personal and professional risk. Greater success was noted when DEI was supported by leadership and included in institutional strategic planning.

Conclusion: DEI is important and necessitates commitment from all levels of leadership, faculty, and strategic planning initiatives. DEI training fills an important role and subsidizes leadership effectiveness as it relates to DEI.