Academic Institutions Research Articles

Association Between the Malnutrition Status and All-Cause Mortality in Patients With Moderate and Severe Aortic Stenosis: AProspective Cohort Study.

Malnutrition status is an important predictor of prognosis in patients after aortic valve replacement. However, the prognostic value of malnutrition status in patients with moderate-to-severe aortic stenosis is unclear. This study aimed to evaluate the effect of malnutrition on all-cause mortality in patients with moderate-to-severe aortic stenosis using the Patient Controlled Nutritional Status (CONUT) score, nutritional risk index, and prognostic nutritional index. A total of 536 patients with moderate-to-severe aortic stenosis were selected in the ARISTOTLE (Aortic Valve Diseases Risk Factor Assessment and Prognosis Model Construction) study conducted between January 2013 and December 2022 in 3 academic institutions. Patients were grouped according to different nutritional status assessment methods. CONUT, nutritional risk index, and prognostic nutritional index were calculated at baseline. The primary study outcome was all-cause mortality. Cox regression was used to assess the association between nutritional status and all-cause mortality. During a median 34.2-month follow-up period, a total of 120 (22.4%) patients died. All-cause mortality was significantly higher in lower prognostic nutritional index, lower nutritional risk index, and higher CONUT groups. Compared with normal nutrition, malnutrition was associated with an increased risk for all-cause death (adjusted hazard ratio for mild and moderate-severe malnutrition, respectively: 2.82 [95% CI, 1.69-4.71; P<0.001] and 3.31 [95% CI, 1.74-6.32; P<0.001] for the CONUT). In patients with moderate or severe aortic stenosis, we found that high CONUT scores, low nutritional risk index scores, and low prognostic nutritional index scores were associated with all-cause death. The poorer the nutritional status, the greater the risk of malnutrition-related all-cause mortality. URL:https://www.clinicaltrials.gov; Unique identifier: NCT06069232.

Emerging patents versus brain eating amoebae, Naegleria fowleri.

Primary Amoebic Meningoencephalitis (PAM) is a severe and often fatal infection caused by the free-living amoebae Naegleria fowleri. This condition typically results from exposure to contaminated warm freshwater/inadequately treated recreational water/or ablution/nasal irrigation with contaminated water. The management of PAM is hindered by the absence of effective treatment coupled with challenges in early diagnosis. This review explores emerging patents that could be utilized for the treatment, diagnosis of PAM, as well as water treatment. Recent patents from the past five years, along with research and innovations are reviewed and categorized into therapeutic agents, water treatment technologies, and diagnostic methods. It is hoped that collaboration and awareness between pharmaceutical companies, water industries, and academic institutions is essential for advancing effective strategies against this severe central nervous system pathogen.

What Physicians Should Consider When Moving Academic Institutions.

There is limited information and guidance for physicians transitioning from one academic institution to another. The following recommendations serve as a resource for academic faculty interested in moving to a different academic institution. The advice falls into three categories of preparation: self-reflection and discernment to determine personal preferences and professional priorities; considerations when preparing for an academic faculty interview; and aspects of the offer, opportunity, and negotiables to discern whether it is right. We acknowledge that the process is nuanced without one strategy that applies to all physicians.

Smartphone Thermal Imaging as an Adjunct to Identify Free Flap Perforators and Assisting Flap Design: A Pilot Study.

The main technique for identification of free flap perforator vessels is Doppler sonography, which is not always accurate, user dependent and affected by the patient's body habitus. Adult patients undergoing head and neck resection and free flap reconstruction at two academic institutions were enrolled. Doppler sonography was used to identify perforators, and were marked using a skin marker. The donor site was cooled down for 3 min using a sterile iced saline bag. FLIR-ONE (FLIR Systems Inc., Wilsonville, OR) camera was used to assess for "hot spots" during a 3-5 min period of re-warming as a surrogate for cutaneous blood flow. The distance between the Doppler signal location, and the "hot spot" was recorded. The position of the perforator was then identified intraoperatively and the distances between the surgical position, the Doppler and "hot spot" were recorded. A total of 28 patients were included. For all flap types, FLIR thermal imaging measurements consistently tended to be closer to the surgical site compared to Doppler ultrasound. In anterolateral thigh flaps (n = 20), thoracodorsal artery perforator flaps (n = 5), and fibula osteocutaneous flaps (n = 3), absolute mean differences ranged from 0.62 to 1.33 cm, with trends favoring FLIR. While paired t-tests did not reach statistical significance, both methods correlated with intraoperatively identified skin perforators, and distances generally ranged between 0 and 2 cm. We demonstrate that a smartphone-based thermal imaging system has the potential to serve as an adjunct for identifying flap perforators, with the possibility of reducing operative times and minimizing patient morbidity. Level 3.

National virtual tumor boards to inform the management of children with rare cancers.

Due to the infrequent nature of rare pediatric cancers, rigorously studied treatment algorithms are usually nonexistent, and experience with a given tumor may be limited at a single institution. Development of treatment plans for these populations often requires extensive literature review and outreach to experts at other institutions. National or international virtual tumor boards provide a streamlined, collaborative approach to discussing diagnosis and management of these patients through dissemination of collective experience and knowledge. This review highlights current virtual tumor boards for rare pediatric cancers and their benefit as a resource for patient care. Over the last several years, national virtual tumor boards sponsored by government and academic institutions and cancer foundations have expanded access of pediatric oncologists to rare tumor expertise and guidance. Recommendations from these tumor boards often have an impact on medical decision making, and some serve as a resource for enduring educational reference materials. National virtual tumor boards are a valuable resource to clinicians caring for patients with rare pediatric tumors. These conferences provide real-time management advice from peers and subject matter experts and provide essential educational content not easily accessible in other formats.

Intro to special issue

In the first of this double issue, we grounded the collection in Mass Culture’s Research in Residence: Arts’ Civic Impact (RinR) project. Aimed at creating a suite of impact measurement frameworks for arts organizations to assess where and how their work has impact, the SSHRC- and Mitacs-funded project embedded four individual graduate student researchers and one team of two graduate students—all from different post-secondary institutions—in arts organizations across the country. Also supported by a group of arts funders comprising an advisory, this first-of-its-kind initiative has had impressive impacts of its own in both the academic and culture sector spheres. Since publishing our first collection of articles, the landscape has changed. RinR’s graduate student researchers have all moved on in some way, be it finishing a master’s degree and starting a doctorate, finishing a doctorate and moving into a post-doctoral fellowship, finishing graduate school and working within an academic institution, and even continuing with their studies while starting a family. Other people involved in RinR have likewise changed jobs or even left the arts sector or academia altogether. Assembling this second issue has afforded us, the co-editors, some very welcome reflection on the project, the relationships we built through it, and how it continues to shape both our individual careers and perspectives on the arts’ civic impact.

Indigenous Ways Infiltrating the Research Realm

The summer of 2021 was the beginning of my experience as a researcher from Emily Carr University of Art &amp; Design on a project that connected me with other researchers across Canada. The project was titled Research in Residence: Arts’ Civic Impact, and was an initiative in collaboration with Mass Culture, the Canada Council for the Arts, the Culture Statistics Working Group, the Ontario Trillium Foundation, and the Toronto Arts Foundation. Each researcher had their own area of interest, with my focus being on researching and exploring the innovative ways of reframing research methods and connecting with communities in the arts sector and academic institutions to align with methods derived from an Indigenous way of gathering information.

Abstract TP141: Who Obtains Informed Consent for Endovascular Thrombectomy in Acute Stroke? A Survey of Clinicians.

Introduction: Informed consent (IC) plays a central role in medical care and research. Practices for endovascular thrombectomy (EVT) in acute stroke are not well elucidated. We investigated the clinical roles and medical specialties of individuals who obtain IC for EVT, aiming to provide insights for enhancing the process in contemporary stroke care. Methods: We conducted a survey from July to December 2023 among clinicians involved in acute stroke care. Utilizing Qualtrics, we disseminated a structured questionnaire through various national and international platforms including the American Academy of Neurology and StrokeNet. This analysis summarizes findings pertaining to the characteristics of those who obtain EVT IC at the respondents’ institution. Results: Among 168 participants, 71% were staff physicians, 70% practiced in the United States (US), and 70% were based at academic centers. The most common medical specialties obtaining EVT IC were neurology (77%), followed by neurosurgery (41%), radiology (30%) and emergency medicine (10%) ( Table 1 ). Staff physician (61%) was the most common clinical role involved, followed by fellows (43%), residents (48%), and advanced practice providers (APP, 36%) ( Table 2 ). Non-US institutions were more likely to utilize a provider from neurology alone (50% vs. 31%, p=0.016) and staff physicians (76% vs. 54%, p=0.008), while US institutions were more likely to utilize providers from neurosurgery (51% vs. 18%, p&lt;0.001), APPs (43 vs. 18%, p=0.002) and residents (56% vs. 28%, p=0.001). Non-academic institutions more frequently used emergency medicine providers (25% vs. 5%, p&lt;0.001) and APPs (50% vs. 31%, p=0.031), while academic institutions commonly utilized neurosurgery providers (48% vs. 18%, p=0.001), residents (59% vs. 13%, p&lt;0.001) and fellows (52% vs. 18%, p&lt;0.001). Conclusion: This study highlights the diverse medical specialties and clinical roles of persons obtaining IC for EVT, with neurologists and staff physicians being the most frequently utilized. These variations likely reflect availability and capacity of certain providers in different settings. Future efforts to optimize the IC process should be multi-disciplinary, with standardized content that addresses issues such as ischemic core volume, outcome expectations and diversity.

Analysis of Timely Follow-Up in the Evaluation of Postmenopausal Bleeding

OBJECTIVE: To characterize guideline-adherent follow-up in patients evaluated with transvaginal ultrasonography (TVUS) for postmenopausal bleeding. METHODS: We conducted a retrospective study of patients with an intact uterus and postmenopausal bleeding who presented to a single academic institution and underwent TVUS between January 2013 and December 2022. Primary outcome measures were prompt follow-up, defined as receipt of endometrial sampling within 3 months of a finding of thickened or inadequately visualized endometrium, diagnosis of endometrial cancer, cancer stage at diagnosis, and rates of tissue sampling. Associations between sociodemographic variables and prompt follow-up were assessed. A Pareto analysis was performed to describe reasons for lack of prompt follow-up. RESULTS: Of 1,671 patients with thickened endometrium, 307 (18.4%) did not receive prompt follow-up; of 389 patients with inadequately visualized endometrium, 128 (33.0%) did not receive prompt follow-up. Sociodemographic variables were not associated with prompt follow-up. Clinician-related factors, including misinterpretation of ultrasound results, accounted for 46.1% of delayed or absent follow-up for thickened endometrium and 58.4% of inadequately visualized endometrium. The rates of diagnosing endometrial cancer within 1 year were similar after findings of thickened endometrium (8.8%; 95% CI, 7.5–10.3%) compared with inadequately visualized (7.7%; 95% CI, 5.3–10.9%) endometrium. CONCLUSION: Clinician misinterpretation of TVUS performed for postmenopausal bleeding was the most common reason for delayed or absent follow-up. Given observed suboptimal rates of prompt follow-up after findings of thickened or inadequately visualized endometrium on ultrasonography and similar rates of an eventual cancer diagnosis in these cohorts, efforts should be focused on clinician understanding of ultrasonographic endometrial evaluation. To simplify the diagnostic process and reduce the risk of missing a cancer diagnosis, universal endometrial sampling for patients with postmenopausal bleeding could be considered.

Disparity Between Perceived and Actual Opioid Prescriptions by Orthopaedic Surgeons After Total Joint Arthroplasty

Introduction: Healthcare institutions have sought to standardize opioid prescribing after elective total joint arthroplasty. The purpose of this study was (1) to compare opioid prescriptions at discharge with perceived opioid prescribing patterns and (2) to determine the relationship between preoperative adjunctive treatments and opioids prescribed at discharge. Methods: All surgeons who performed total joint arthroplasty of the shoulder, hip, or knee from January 1, 2021, to October 4, 2023, at a single academic institution were included. Surgeons completed a survey assessing perceived opioid prescriptions at discharge and perioperative pain protocols. Actual prescriptions were captured using our institutional opioid database. All opioid prescriptions were converted to morphine milligram equivalents (MMEs). Results: Orthopaedic surgeons prescribed on average 594.2 MMEs more than they perceived as their postoperative protocol. They prescribed an additional 60.9 MMEs for every 10 MMEs that they perceived they were prescribing. Patients receiving liposomal bupivacaine were prescribed on average 597 fewer MMEs and had fewer opioid prescriptions (P &lt; 0.001). Genicular nerve blocks and cryoneurolysis were associated with fewer prescribed MMEs (P &lt; 0.001). Conclusion: Orthopaedic surgeons prescribe substantially more opioids than intended. This study underscores the need for standardized opioid prescribing practices and the potential of adjunctive treatments in reducing opioid prescribing.

Barriers to Research for Academic Otologists/Neurotologists in the United States.

The physician-scientist workforce is shrinking in the United States. Academic otologists/neurotologists face a diverse set of barriers to successful careers. We aimed to characterize the factors affecting contemporary otology/neurotology surgeon-scientists. An electronic survey was distributed to faculty members of the American Neurotology Society and the American Otological Society in 2021. The survey queried demographics, practice setting, compensation, and barriers to conducting research for respondents in academic practice. One hundred fifty-seven otologists/neurotologists responded to the survey, corresponding to an overall response rate of 25%. Of the respondents, 94 were in academic practice. The median protected research time was 0.5 days/wk, whereas the mode was zero. Across academic rank, salary compensation was lower for academic surgeons with active research funding and for female academic surgeons as compared with their male counterparts. Grant-funded female academic surgeons had significantly worse compensation compared with rank-matched male surgeons with similar protected time. No grant-funded female earned more than the 30th percentile for their rank. Identified barriers to research were pressure to maintain clinical productivity, insufficient protected time, and personal/family demands. Respondents highlighted several areas for improvement: compensation for research activity, administrative support, and improved grant funding mechanisms for clinician-scientists. Otology/neurotology surgeon-scientists face barriers to research, including limited protected time, poor administrative support, increasingly competitive funding environments, and misaligned compensation models. New initiatives by the National Institute on Deafness and other Communication Disorders aim to increase the surgeon-scientist workforce, but their success may depend upon removing identified barriers at the level of academic institutions.

Sentiment analysis study of library services using support vector machine methodse

Academic institutions' libraries contribute significantly to students' success by giving them access to the information resources they need. Sentiment analysis of library services is crucial in the current digital era to comprehend student perspectives and enhance service quality. The purpose of this study is to assess how XYZ University students feel about the library services thereby applying the Support Vector Machine (SVM) technique. Data obtained through a survey utilizing a Google Form is used in this study to analyze sentiment using the SVM algorithm. Preprocessing steps include data cleaning, normalization, tokenization, stopword removal, and stemming. Eighty percent of the data were used to train the SVM model, while twenty percent of the data were used to test it. The evaluation findings demonstrated that the SVM model could classify sentiment with a 90% accuracy level. This result was confirmed using an accuracy, precision, recall, and F-measure metrics confusion matrix. The sentiment analysis's findings revealed that most students had a favorable opinion of the library's services, particularly when it came to the staff's effectiveness and the facilities' cleanliness. But there are still certain areas that require work, including managing noise and adding more pertinent book selections. To increase overall library user happiness, it is advised to put in place a program that focuses on enhancing the quality of a quieter learning environment and providing a selection of books that meet the needs of students

Predicting accrual success for better clinical trial resource allocation

Accrual success is one key determining factor for the success of clinical trials. Global data analyses of all terminated trials reported that 55% of trials were terminated due to low accrual rates. Failure to meet accrual goals have a significant impact on costs for sponsors, academic institutions, investigators, and society at large. The ability to predict trial accrual success with high precision before the trial starts would be highly valuable, preventing the allocation of critical resources for trials unlikely to meet accrual goals. In the present study, we constructed a dataset for predicting clinical trial failure based on poor accrual using clinicaltrial.gov data containing information on 57,846 trials. Features of the dataset were informed by prior literature and constructed using data-driven natural language processing methods. We built predictive models for accrual failure using state-of-the-art supervised machine learning protocols and methods. Models resulted in good predictive performance that was stable over a 10-year time period, with predictive performance of cross-validation AUC = 0.744 (+/-0.018) and prospective validation AUC = 0.737 (+/-0.038). We also improved model calibration and examined model performance with the reject option. These modifications enable model translation into decision support tools for various real-world settings. To the best of our knowledge, this is the first study to develop models for predicting clinical trial failure due to accrual based on a large dataset with a comprehensive set of trial features.

Virtual laboratories complement but should not replace face-to-face classes: Perceptions of life science students at Dundalk Institute of Technology, Ireland.

Virtual laboratories (VLs) enable students to experiment, analyze data or interact with digital content in a non-physical space. VLs include simulations, electronic notebooks, videos and augmented reality. As part of the 'VL Project', comprising 5 academic institutions in Ireland, we sought to determine how VLs might enhance practical learning in undergraduate life science students at Dundalk Institute of Technology (DkIT). From 2021-2024, we exposed students to VLs multiple degrees (e.g. BSc Bioscience, BSc Pharmaceutical Science, BSc Biopharmaceutical Science). We focused on Labster simulations, and Lab Archives electronic notebooks. Over 600 students performed VLs in 14 modules from 1st-4th year (e.g. Biotechnology, Immunology, Bioanalytical Science). We surveyed students before, and after using VLs and conducted focus groups to evaluate emergent themes in depth. Among respondents (n=263), the most beneficial component of laboratory experiences, as indicated by 58% of students was experimental work (opposed to pre-practical talks or post-laboratory assessments). 90% of students agreed with the statement: "VLs enhanced my level of confidence with experimental science". 75% of students stated VLs should only be used to complement face-to-face (F-2-F) teaching. Thematic focus group analysis revealed students valued VLs as pre-lab tools, allowing repeated engagement with, and troubleshooting of experiments in a safe, non-time limited manner. In conclusion, students reinforced they valued hands-on experience, in-person instructor guidance and real-world demonstration for experimental work. VLs can complement, but should not replace face-to-face laboratory experiences in undergraduate life sciences.

Understanding and counteracting the denial of insect biodiversity loss.

Biodiversity loss is occurring globally with negative impacts on ecosystem function and human wellbeing. There is a scientific consensus that diverse environmental and anthropogenic factors are altering different components of insect biodiversity, with changes occurring at all levels of biological organisation. Here we describe how uncertainty around specific trends and the semantics of 'decline' in relation to insect biodiversity have been leveraged by denialist campaigns to manufacture doubt around the insect biodiversity crisis. Disinformation is one of the biggest threats to social cohesion and environmental integrity globally. We argue that scientists, academic institutions, policy makers, and journalists must combat denialism by relying on robust research, supporting efforts to communicate scientific uncertainty more effectively, and build consensus on the global impacts of insect biodiversity loss.

Risk prediction model of pedicle screw loosening within 2 years after decompression and instrumented fusion surgery for degenerative lumbar disease.

Pedicle screw loosening (PSL) after spinal fusion surgery is one of the most frequently reported complications and leads to poor clinical outcomes. This study aimed to develop and validate a risk prediction model for PSL within two years in patients undergoing lumbar instrumented fusion surgery based on their risk profiles. Retrospective, observational study. Patients who underwent lumbar instrumented fusion surgery at a single academic institution between May 2015 and February 2019. Risk assessment of PSL and development of a rating score based on patient characteristics. The demographic profiles and radiographic parameters using computed tomography were obtained. These factors were analyzed to determine possible risk factors related to postoperative PSL after 2 years. A scoring system was developed using these independent risk factors and validated using prospectively collected data from another center between May 2019 and December 2021. The occurrence of PSL within 2 years postoperation was 12.7% (40/315). PSL was significantly predicted by smoking, low Hounsfield units (HU) of the pedicle tract at the index level (P), and a low psoas-lumbar vertebral index (PLVI). The risk of PSL according to the categories of the risk score was 1.1% for those with a score of 0-1, 15.1% for a score of 2-3, and 61.5% for a score of 4-6. In validation, this model demonstrated both good discrimination and calibration results. The area under the curve was 0.887 (95% CI 0.830-0.938) for the derivation cohort and 0.835 (95% CI 0.738-0.918) for the external validation cohort. This PSL risk score, including smoking, Index P HU, and PLVI, is a novel approach to predict PSL 2 years post-surgery. This approach highlights the role of factors associated with osteoporosis and sarcopenia in the development of PSL and could aid in preoperative decision-making and surgical planning.

Revision Surgery Rates Following Transforaminal Lumbar Interbody Fusion in Patients with and without Osteoporosis.

Osteoporosis is becoming increasingly prevalent in the spine surgery population and has been shown to be associated with surgical failure in spinal deformity operations. Little is known about the impact of osteoporosis on radiographic and surgical complications following degenerative fusion techniques. To compare complications and radiographic alignment in osteoporotic versus non-osteoporotic patients undergoing transforaminal lumbar interbody fusion (TLIF). Retrospective cohort study. A total of 78 patients, 39 with osteoporosis and 39 without osteoporosis, were included in this study. The following data were observed for all cases: patient demographics, radiographic alignment, and complications. Adult patients with two-year follow-up who underwent transforaminal lumbar interbody fusion (TLIF) at a single academic institution were identified. Eligible patients were propensity matched by the presence of osteoporosis while accounting for age, sex, and BMI. Patient demographics, procedural characteristics, preoperative to two-year postoperative change in spinopelvic alignment, and complications were compared. Multivariate regression analyses, accounting for age, gender, and Charlson Comorbidity Index (CCI), were performed to evaluate outcomes following TLIF. In total, 78 patients with complete data were included with a mean age of 63.28, 70.51% were female, mean CCI was 1.02 and mean clinical follow up was 33.3 months. At two years postoperatively, osteoporosis patients had a significantly greater increase in PI-LL from pre-operation (6.55° vs -0.02°, p=0.010). In addition, while there was no statistically significant difference in medical and surgical complication (all p>0.05), osteoporosis patients were 2.8 times more likely to develop adjacent segment diseases (p=0.05). Additionally, over 30% of patients with osteoporosis underwent revision and osteoporotic patients were 9.2 times more likely to undergo revision (p=0.008) than patients without osteoporosis, most commonly for adjacent segment disease. In this single-center multi-surgeon study, osteoporotic patients experienced significant worsening of PI-LL mismatch postoperatively and had a higher incidence of adjacent segment disease and revision. Although TLIF remains an important procedure in osteoporotic patients, increased care should be taken to optimize bone quality in the perioperative period to avoid potential mechanical and surgical complications.

Analysis of the role of food crop integration and beef cattle on the income of farmers in Tibawa Sub-District Gorontalo District

The objective of the present study is to formulate strategies for the integration of food crops and beef cattle on farmers' income in Tibawa District, Gorontalo Regency. The present study employs a quantitative research method. The study's participants comprised 30 individuals. The data were collected through the administration of questionnaires, which served as the primary data source. The collected data underwent a quantitative descriptive analysis (SWOT). The study's findings indicate that the development strategy for the crop and beef cattle integration system on farmers' income in Tibawa District, Gorontalo Regency, falls within quadrant 3, categorically identified as the Turn Around strategy or W-O strategy (Weaknesses-Opportunities). This strategy underscores that endeavors to enhance the development of an integrated system of food crops and beef cattle on the income of farmers in Tibawa District, Gorontalo Regency, can be centered on amplifying diverse opportunities to mitigate various weaknesses, thereby ensuring the effective and sustainable functioning of the integration system. The implementation of this strategy is predicated on three fundamental approaches: (1) training and skill development, (2) the reinforcement of cooperative networks, and (3) the forging of partnerships with academic institutions such as universities or research organizations.

Exploring community stakeholder perspectives of partnership development in community-engaged undergraduate Global Health Education in the UK: a qualitative study

ObjectivesTraditionally, patients have had passive roles in medical education; however, there have been increasing efforts to partner with communities to create authentic representation of laypeople in medical education. Communities’ perspectives...

Community Racial and Ethnic Representation Among Physicians in US Internal Medicine Residency Programs.

Increasing underrepresented in medicine (URIM) physicians among historically underserved communities helps reduce health disparities. The concordance of URIM physicians with their communities improves access to care, particularly for American Indian and Alaska Native, Black, and Hispanic or Latinx individuals. To explore county-level racial and ethnic representation of US internal medicine (IM) residents, examine racial and ethnic concordance between residents and their communities, and assess whether representation varies by presence of academic institutions or underserved settings. This retrospective cross-sectional study collected data from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education (ACGME), Area Health Resources Files, and US Department of Education data on ACGME-accredited US IM residency programs and their associated county populations. Self-reported racial and ethnic data from 2018 for 4848 residents in 393 IM programs in 205 counties were used. Data were analyzed between February 15 and September 20, 2024. County-level presence for academic health centers (AHCs), minority-serving institutions (MSIs), health professional shortage areas (HPSAs), and rurality. Main outcomes were representation quotients (RQs) or the ratio of the proportion of IM residents and their concordant county-level racial and ethnic populations. Quantile linear regression models on median representation were used to identify the association with URIM, Asian, and White residents by US Census division and county-level AHCs, MSIs, HPSAs, and rurality. Among 4848 residents, 4 (0.08%) self-identified as American Indian or Alaskan Native, 1709 (35.3%) as Asian, 289 (6.0%) as Black, 211 (4.4%) as Hispanic or Latinx, 2 (0.04%) as Native Hawaiian or Other Pacific Islander, and 2633 (54.3%) as White. A total of 761 (15.7%) were classified as URIM. Among URIM groups, American Indian and Alaska Native (mean [SE] RQ, 0.00 [0.04]), Black (mean [SE] RQ, 0.09 [0.20]), Hispanic and Latinx (mean [SE] RQ, 0.00 [0.04]), and Native Hawaiian and other Pacific Islander (mean [SE] RQ, 0.00 [0.26]) residents were grossly underrepresented compared with their training sites' county-level representation. Fifty-one of 205 counties (24.8%) with IM programs had no URIM residents. Black and Hispanic or Latinx residents had higher representation in counties with more MSIs (mean [SD] RQ, 0.19 [0.24]; P = .04; mean [SD] RQ, 0.15 [0.04]; P < .001, respectively), and Hispanic or Latinx residents were less represented in counties with more AHCs (mean [SD] RQ, 0.00 [0.06]; P < .001). Asian residents had lower RQs in counties with more MSIs (mean [SD] RQ, 6.00 [0.65]; P < .001), and White residents had higher representation in counties with greater presence of AHCs (mean [SD] RQ, 0.77 [0.04]; P = .007). In this cross-sectional study, URIM IM residents remained underrepresented compared with their program's county populations. These findings should inform racial and ethnic diversity policies to address the continuing underrepresentation among graduate medical education physicians, which adversely impacts the care of historically underserved communities.