Underrepresented In Medicine Research Articles

A Virtual National Diversity Mentoring Initiative to Promote Inclusion in Emergency Medicine.

Trainees underrepresented in medicine (URiM) face additional challenges seeking community in predominantly white academic spaces, as they juggle the effects of institutional, interpersonal, and internalized racism while undergoing medical training. To offer support and a space to share these unique experiences, mentorship for URiM trainees is essential. However, URiM trainees have limited access to mentorship from URiM faculty. To address this gap, we developed a national virtual mentoring program that paired URiM trainees interested in emergency medicine (EM) with experienced mentors. We describe the implementation of a virtual Diversity Mentoring Initiative (DMI) geared toward supporting URiM trainees interested in EM. The program development involved 1) partnering of national EM organizations to obtain funding; (2) identifying a comprehensive platform to facilitate participant communication, artificial intelligence-enabled matching, and ongoing data collection; 3) focusing on targeted recruitment of URiM trainees; and (4) fostering regular leadership meeting cadence to customize the platform and optimize the mentorship experience. We found that by using a virtual platform, the DMI enhanced the efficiency of mentor-mentee pairing, tailored matches based on participants' interests and the bandwidth of mentors, and successfully established cross-institutional connections to support the mentorship needs of URiM trainees.

Impact of Gender and Underrepresented in Medicine Status on Research Productivity Among Ophthalmology Residency Applicants

Insufficient representation of women and underrepresented in medicine (URiM) students remains a problem among the ophthalmology workforce. In the residency selection process, research productivity is an important factor. We aimed to determine the average research output listed by applicants and assess for differences by gender and race. Retrospective cohort study. All San Francisco Match applications to the Wilmer Eye Institute for the 2019, 2020, and 2021 ophthalmology residency cycles were retrospectively reviewed. Each applicant's number of published research articles was recorded and subclassified into first-author publications in any field, publications in ophthalmology, and first-author publications in ophthalmology. Multivariable logistic regression was performed to determine factors associated with successful publication. A total of 1376 applications were reviewed. On average, women had a greater number of publications in ophthalmology (2.08 vs 1.73, P=.05) and presentations (4.52 vs 4.09, P=.01) compared with men. Self-identified URiMs were less likely to list publications in ophthalmology (odds ratio [OR] 0.650, P=.05) and first-author publications in ophthalmology (OR 0.570, P=.02) compared to non-URiMs. Our findings highlight disparities in research productivity by self-identified URiM status. On the other hand, women had similar if not higher research outputs than men. Greater research mentorship and opportunities to support URiM students may facilitate the recruitment of diverse trainees to ophthalmology programs.

Implicit Association Test Alone Is Not Sufficient to Increase Underrepresented Minority Representation in Physician Assistant Programs.

Physician assistant (PA) program matriculants are consistently less diverse than the US population. This study evaluates whether administration of an Implicit Association Test (IAT) to PA program admission committees is associated with changes in the likelihood of (1) receiving an admission interview, (2) receiving an offer of admission, and (3) matriculation of individuals underrepresented in medicine (URiM). Admission committees from 4 PA programs participated in an IAT before the 2019/2020 admissions cycle. Applicant outcome data (n = 5796) were compared with 2018/2019 cycle (n = 6346). Likelihood of URiM students receiving offers to interview, offers of admission, and matriculation were evaluated using random effects multiple logistic regression models. Fully adjusted random effects models included URiM status, year (control vs. intervention), multiplicative interaction terms between URiM and year, applicant age, and undergraduate grade point average (GPA) Secondary analyses examined associations of each race/ethnicity individually. Underrepresented in medicine status, age, and GPA were significantly associated with all admission outcomes ( P < .05). The intervention effect was not statistically significant. In sensitivity analyses examining each individual race rather than URiM status, our results did not importantly differ. Findings suggest admission committee member participation in IAT before admissions had no significant impact on the likelihood of admission of URiM students. This may suggest that making individuals aware of their implicit biases is not, in and of itself, sufficient to meaningfully affect the diversity of PA program admission metrics.

Racial and Ethnic Diversity in Medical School Admissions in Canada

Medical schools promote admission pathways as well as diversity and inclusivity to prospective students who are underrepresented in medicine (UIM) primarily via their websites. Research from organizational structures supports the use of instrumental values (which focus on behavior and core beliefs), rather than terminal values (which focus on the end goal), to promote diversity. To characterize the use of instrumental and terminal values to promote institutional diversity and inclusivity on Canadian medical school websites. This qualitative study analyzed the contents and themes of Canadian medical school websites based on a theoretical value framework and an organizational diversity management framework. A literature review was conducted to explore the use of instrumental and terminal values in promoting diversity and inclusivity, and a codebook was created that outlined the characteristics of these values. The content of all application pathway websites for UIM applicants to all Canadian medical schools was coded between July and August 2022. Use of terminal vs instrumental values across the UIM-targeted admission websites of medical schools. Twenty-two websites for 17 Canadian medical schools were included. Content on most of these websites promoted diversity in response to government policies or public accountability and often supported a dominant culture while treating diversity as an exception. The use of terminal rather than instrumental values was also more prominent on websites that targeted Indigenous prospective students compared with Black prospective students and applicants with lower socioeconomic status (11 [50%] websites vs 5 [23%] and 4 [18%] websites). Instrumental values, although seldom used, promoted diversity as a means to improve health care and training for all students in a program. Results of this qualitative study suggested that medical schools in Canada promoted diversity and inclusivity to prospective students primarily as an end goal rather than as a core value. Medical schools should highlight the benefits of diverse lived experiences and reinforce their commitment to diversity and inclusion by aligning their website content with their ongoing work in this area.

Predictors of applicant pool racial and ethnic diversity among physician assistant education programs: a national cross-sectional cohort study

BackgroundNumerous studies have demonstrated that the increasing racial and ethnic diversity of the US population benefits from access to healthcare providers from similarly diverse backgrounds. Physician assistant (PA) education programs have striven to increase the diversity of the profession, which is predominantly non-Hispanic white, by focusing on admitting students from historically excluded populations. However, strategies such as holistic admissions are predicated on the existence of racially and ethnically diverse applicant pools. While studies have examined correlates of matriculation into a medical education program, this study looks earlier in the pipeline and investigates whether applicant – not matriculant – pool diversity varies among PA programs with different characteristics.MethodsData were drawn from the 2017–2018 Central Application Service for PAs admissions cycle. Applications to programs with pre-professional tracks and applicants missing race/ethnicity data were excluded, resulting in data from 26,600 individuals who applied to 189 PA programs. We summarized the racial and ethnic diversity of each program’s applicant pools using: [1]the proportion of underrepresented minority (URM) students, [2]the proportion of students with backgrounds underrepresented in medicine (URiM), and [3]Simpson’s diversity index of a 7-category race/ethnicity combination. We used multiple regressions to model each diversity metric as a function of program characteristics including class size, accreditation status, type of institution, and other important features.ResultsRegardless of the demographic diversity metric examined, we found that applicant diversity was higher among provisionally accredited programs and those receiving more applications. We also identified trends suggesting that programs in more metropolitan areas were able to attract more diverse applicants. Programs that did not require the GRE were also able to attract more diverse applicants when considering the URM and SDI metrics, though results for URiM were not statistically significant.ConclusionsOur findings provide insights into modifiable (e.g., GRE requirement) and non-modifiable (e.g., provisionally accredited) program characteristics that are associated with more demographically diverse applicant pools.

Building Approachable Surgical Experiences (BASE) in High School Populations

Pipeline programs are often set up to bring more diverse candidates to medical schools with the goal of diversifying the physician workforce in the years to come. All too often, these programs begin in college, long after many students of diverse backgrounds have been left behind through a myriad of barriers that exist between entering high school and matriculating to medical school. The Building Approachable Surgical Experiences (BASE) outreach program was designed to showcase healthcare careers, with an emphasis on surgical subspecialties, to historically underserved high school students. This pilot program's goal was to increase high school students' interest and confidence in pursuing future medical and surgical careers and provide a platform to initiate mentorship. Local high school students from underrepresented in medicine (URiM) populations or medically underserved communities were invited to spend the day at an academic medical school campus. These students engaged in hands-on clinical and basic operative skill workshops led by third- and fourth-year medical students. They also engaged in small group conversations centered on mentorship with surgical residents and faculty. Program implementation took place at an academic medical center school of medicine in an urban city. Forty high school students, 16 medical students, and 2 surgery faculty participated in this pilot program. This event allowed early exposure for high school students to surgical and medical specialties, clinical techniques, and surgical mentorship. From the connections made, students have developed mentorship relationships and have felt comfortable reaching out with questions regarding the steps required to seek entrance to medical school. Mentors are currently resident or attending physicians, which provides students from underrepresented populations an opportunity for direct insight and guidance to and through the path to becoming a physician. Based on qualitative feedback from students, their high school teachers, and administrators, this pilot program succeeded in providing a window into healthcare, using a format that was encouraging to students long beyond their time on the school of medicine campus.

At the Intersection of Intersectionality: Race and Gender Diversity Among Surgical Faculty and Trainees.

To compare the representation of intersectional (ie, racial/ethnic and gender) identities among surgical faculty versus medical students. Health disparities are pervasive in medicine, but diverse physicians may help the medical profession achieve health equity. Data from the Association of American Medical Colleges for 140 programs (2011/2012-2019/2020) were analyzed for students and full-time surgical faculty. Underrepresented in medicine (URiM) was defined as Black/African American, American Indian/Alaskan Native, Hispanic/Latino/Spanish Origin, or Native Hawaiian/Other Pacific Islander. Non-White included URiM plus Asian, multiracial, and non-citizen permanent residents. Linear regression was used to estimate the association of year and proportions of URiM and non-White female and male faculty with proportions of URiM and non-White students. Medical students were comprised of more White (25.2% vs 14.4%), non-White (18.8% vs 6.6%), and URiM (9.6% vs 2.8%) women and concomitantly fewer men across all groups versus faculty (all P < 0.01). Although the proportion of White and non-White female faculty increased over time (both P ≤ 0.001), there was no significant change among non-White URiM female faculty, nor among non-White male faculty, regardless of whether they were URiM or not. Having more URiM male faculty was associated with having more non-White female students (estimate = +14.5% students/100% increase in faculty, 95% CI: 1.0% to 8.1%, P = 0.04), and this association was especially pronounced for URiM female students (estimate = +46.6% students/100% increase in faculty, 95% CI: 36.9% to 56.3%, P < 0.001). URiM faculty representation has not improved despite a positive association between having more URiM male faculty and having more diverse students.

Unmasking Structural Racism in U.S. Medical Education: Advancing Equity for Underrepresented Medical Students

The COVID pandemic cast a harsh light on the structural and systemic health inequalities that exist in American society and in U.S. medical education. Black and Brown communities were disproportionately affected, and the pandemic highlighted the need for a diverse physician and healthcare workforce. Both the lack of equitable, high-quality healthcare in underrepresented communities and the obstacles that students who are underrepresented in medicine (URiM) experience in medical school are direct consequences of the structural racism that flourishes in U.S. medical schools and healthcare institutions. In this article, we explain structural racism and how it has manifested itself in medical education, including the lack of diversity among faculty and leadership, implicit biases and stereotypes about people of color, and discriminatory language used in evaluations of URiM students. We conclude with potential solutions for addressing structural racism in medical education. These include increasing diversity among faculty and leadership, implementing antiracist curricula, and providing mentorship and support for URiM students. Ultimately, we aim to promote discussion and action to eliminate structural racism in medical education in America.

Diversity in interventional radiology: Survey of medical student interest with focus on women and members of underrepresented in medicine racial and ethnic groups

PurposeTo assess: 1) the percentage of female and underrepresented in medicine (URiM) medical students interested in interventional radiology (IR), and 2) the motivations for and deterrents from IR for female and URiM students. MethodsThe study was IRB exempt. Data from a 19-item survey sent to 5 US medical schools were collected from 10/2018–01/2019 using REDCap and analyzed with SAS GLIMMIX. Results16% (56/346) of women and 27% (69/258) of men strongly considered IR. 21% (19/89) of URiM versus 21% (105/508) of non-URiM students, p = .88, seriously considered IR.On a 0-to-4 scale (0 = not a motivator, 4 = strong motivator), women rated “Female mentorship” “2.5” versus males' “0.4”, p < .0001, independent of IR interest URiM students uninterested in IR rated “Lack of ethnic diversity in training”“2.3” versus “1.2” for IR-interested URiM, p < .01.18% (9/50) of IR-interested women reported adequate gender-specific mentorship in IR in medical school. Of IR-interested URiM students 5% (1/19) reported adequate ethnicity/race-specific mentorship. ConclusionFewer female medical students considered IR compared to males. Female mentorship was a significant motivator for women. Similar numbers of URiM and non-URiM students consider IR. Few women and URiM students report adequate gender/ethnicity/race-specific mentorship. For students not interested in IR, lack of ethnic diversity in training was a significant deterrent. Increasing numbers and visibility of female and URiM interventional radiologists in mentoring and clinical practice may improve recruitment of medical students from these underrepresented groups.

Utilizing Television Clips for Graduate Medical Education Anti-racist Curricula: An Acceptability Study.

Introduction Racism is a pervasive social problem that influences medicine, highlighting the need for interventions. One promising educational technique, referred to as edutainment, utilizes clips from television shows as an instructive strategy. The objective of this study was to examine the acceptability of edutainment around anti-racist curricula for residents. Methods We conducted a survey of underrepresented in medicine (URM) medical faculty to inform content for subsequent focus groups with medicine, psychiatry, and pediatrics residents. For the survey, URM faculty were randomly assigned to view four of eight clips and responded to close- and open-ended items. Focus group participants viewed selected clips and provided feedback. All study procedures occurred in 2020-2021. We calculated descriptive statistics for close-ended survey items and employed thematic analysis for open-ended items and focus group transcripts. Results Twelve URM faculty completed the survey. Feedback was uniformly positiveso we included all eight clips in the resident focus groups. For each of the three participating specialties, we conducted two focus groups (2-11 participants each, total n=25) with participants viewing four of the eight clips. Analysis of focus group transcripts found that participants were receptive to the edutainment approach. Feedback as to the realism and acceptability of certain clips differed by specialty. Triangulation of survey and focus group results found differences in the acceptability of specific clips between residents and faculty. Conclusion Edutainment with medical television shows may be a promising avenue for anti-racist curricular content for residents. The educational methods described here are being incorporated into a multi-pronged, hospital system wide graduate medical education anti-racist curriculum.

URiMs and Imposter Syndrome: Symptoms of Inhospitable Work Environments?

Workforce diversity is associated with improved health outcomes. Currently, primary care physicians who are underrepresented in medicine (URiM) disproportionately work in underserved areas. Increasingly, URiM faculty describe experiencing imposter syndrome (IS), including a sense of not belonging in their work environment and a lack of recognition. Studies of IS among family medicine faculty are not prevalent nor are the factors most associated with IS among URiMs and non-URiMs. The objectives of our study were to (1) determine prevalence of IS among URiM faculty compared to non-URiM faculty; (2) determine factors associated with IS among both URiM and non-URiM faculty. Four hundred thirty participants completed anonymous, electronic surveys. We measured IS using a 20-item validated scale. Among all respondents, 43% reported frequent/intense IS. URiMs were not more likely than non-URiMs to report IS. Factors independently associated with IS for both URiM and non-URiM respondents include inadequate mentorship (P&lt;.05) and poor professional belonging (P&lt;.05). However, inadequate mentorship, low professional integration and belonging, and racial/ethnic discrimination-based exclusion from professional opportunities (all P&lt;.05) were more prevalent among URiMs than non-URiMs. While URiMs are not more likely than non-URiMS to experience frequent/intense IS, they are more likely to report racial/ethnic discrimination, inadequate mentorship, and low professional integration and belonging. These factors are associated with IS and may be reflective of how institutionalized racism impedes mentorship and optimal professional integration, which may be internalized and perceived as IS among URiM faculty. Yet, URiM career success in academic medicine is crucial for achieving health equity.

Changing Missions of Medical Schools and Trends in Medical Student Diversity.

Improving diversity in the physician workforce continues to be a challenge and a priority for medical schools. Establishing a school-wide mission statement that addresses diversity, equity, and inclusion can help support efforts to increase the number of underrepresented in medicine (URM) graduates. In this study, we analyzed changes in medical school mission statements between 2013 and 2021 and correlated changes in mission statements with trends in URM student representation. We performed a web search of 136 medical schools' mission statements and categorized them based on whether they changed their mission statement to add diversity or equity language. We then obtained demographic data of enrolled students at each school and identified the percentage of students identifying as URM in each academic year. We used mixed-effects regression and pair fixed effects linear regression to examine trends in URM student representation and the association between URM student representation and whether a school added diversity and equity content to its mission statement. We found that URM student representation increased by 0.4% per year at schools that added diversity and equity content to their mission statements. Changing medical schools' mission statements to reflect values of diversity, equity, and inclusion was associated with an increase of less than a 1% per year in URM representation. More research is needed to explore relationships between URM representation and medical school mission statements.

Making an Impact with E.M.P.A.C.T. Engage, Mentor Prepare, Advocate, Cultivate, and Teach: An Innovative Pilot Mentoring Program Evaluation for Students Underrepresented in Medicine.

Medicine has yet to increase the representation of historically excluded persons in medicine to reflect the general population. The lack of support and guidance in the medical training of these individuals is a significant contributor to this disparity. The Engage, Mentor, Prepare, Advocate for, Cultivate, and Teach (EMPACT) Mentoring program was created to address this problem by providing support for learners who are historically underrepresented in medicine (URiM) as they progress through medical school. The EMPACT Pilot Program was formed and conducted during the 2019-2020 academic year. A total of 19 EMPACT mentorship groups were created, each consisting of two mentors and four medical student mentees. Additionally, four professional development workshops were held along with a final Wrap-up and Awards event. Pre and post pilot program surveys along with surveys after each workshop and focus groups were conducted with a random selection of program participants. When compared to data from before and after the implementation of the EMPACT program, there were statistically significant differences (p < 0.05) in EMPACT mentees reporting they agree or strongly agree they felt ready to handle their clinical rotations (28% to 65%), felt the need to have an advocate (85% to 47%), possessed insight on day-to-day activities of an attending (26% to 56%) and felt a sense of community (79% to 94%). Mentors revealed an increase in their awareness of the concepts of microaggressions and imposter phenomenon. Finally, both groups felt an increase in their support system and sense of community at the school of medicine. Despite COVID-19 limitations, the EMPACT program met its goals. We effectively supported URiM medical students through mentorship, networking, and community.

The Matthew Effect: Prevalence of Doctor and Physician Parents among Ophthalmology Applicants.

Objective This article determines the prevalence of physician parents among ophthalmology residency applications. Design Retrospective, single-center cohort study. Subjects All applicants to the University of Kentucky Ophthalmology Residency between 2018 and 2023. Methods Residency applications were reviewed, with data collection including applicant gender, self-identified Under-Represented in Medicine (URiM) status, United States Medical Licensing Examination (USMLE) Step 1 score, USMLE Step 2 score, and whether the application identified a doctor or physician as a parent. Doctor was defined as a profession requiring a doctorate degree, and similarly, physician as a profession requiring a medical degree. Results A total of 2,057 applications were reviewed, representing 54% of all match participants during the study period. Fourteen percent (296) of applications indicated a parent was a doctor and 12% (253) a parent was a physician. There were no differences between gender, URiM, USMLE Step 1, and Step 2 scores between applicants indicating a doctor or physician as a parent and those that did not ( p all > 0.4 and Cohen's d all < 0.02). Of the type of doctors, 85% (253) were physicians, 6% (17) optometrists, 6% (17) Doctors of Philosophy, 3% (8) dentists, 1% (1) pharmacist, and 1% (1) veterinarian. Eighty-six percent (217) of applications with a physician parent provided the type of physician, with ophthalmologist the most common (93, 43%). Ninety-eight percent (249) of applications with a physician parent provided the gender of the parent, with father (168, 68%) more common than mother (42, 17%) or both parents (39, 16%). Conclusion Physician parents are substantially overrepresented in ophthalmology residency applicants. This raises concerns regarding diversity and inclusion efforts for recruitment in medicine.

Diversity-Related Positions in Orthopaedic Surgery Residency Programs.

The Association of American Medical Colleges and the American Academy of Orthopaedic Surgeons have incorporated diversity and inclusion as one of their primary goals. Orthopaedic surgery remains the least diverse medical specialty when measured for practicing physicians and trainees. The purpose of this study was to determine the number and distinct types of diversity, equity, and inclusion (DEI) positions within orthopaedic surgery residency programs in the United States. The Fellowship and Residency Electronic Interactive Database was used to obtain a list of all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs. The following was collected from 193 residency program websites between June 6, 2022, and June 26, 2022: program location, university or community based, allopathic or osteopathic recognition, number of faculty in the orthopaedic department, number of residents per year, diversity-related statements, and diversity-focused faculty positions. Of the 193 programs evaluated, 74 (38.9%) included DEI statements on their website while only 42 (21.8%) had at least one DEI-specific faculty role (e.g., diversity committee, diversity liaison, vice chair for DEI). For 16 (8.3%) programs, the faculty role was nonspecific to the orthopaedic residency program. Nonspecific roles were primarily created by the affiliated school of medicine, but in 4 (2.1%) outlier cases, faculty members assumed DEI roles through a medical center, a graduate medical education program, or a department of surgery. Less than half of orthopaedic surgery residency programs currently advocate for DEI on their associated websites while fewer than 25% have a DEI faculty position. Previous studies have called for a greater number of DEI positions and committees among orthopaedic residencies because of the lower admittance rate of qualified Under Represented in Medicine (URiM) applicants. A role dedicated to DEI may increase the number of women and URiM applicants pursuing a career in orthopaedic surgery.

Racial and Ethnic Disparities in Selected Speakers at Plastic Surgery Conferences.

The researchers evaluated selected speakers at 12 plastic surgery annual meetings over 7 years (2014-2020). Racial and ethnic distribution in selected speakers at conferences were compared with those of medical school graduates, plastic surgery residents, and practicing plastic surgeons. There were a total of 79 meetings, with 8931 total speaking opportunities and 1276 unique speakers. The percentage of individuals underrepresented in medicine (UIM) is 15.2% in matriculating medical students, 8.9% in active PRS residents, 8.3% in practicing PRS physicians, and 4.7% in invited conference speakers. Within racial/ethnic groups of invited speakers, there was no significant difference in either the average number of fellowships completed or average number of plastic surgery publications (P = 0.44 and 0.39, respectively). No individual UIM speaker had more than 20 speaking opportunities over these 7 years, compared with 17.0% in non-UIM speakers. Given the results of the study, the researchers conclude that racial minorities are disproportionately underrepresented as selected speakers at plastic surgery conferences, despite similarities in qualifications such as fellowship training, publication number, and years since board certification.

Enhancing Curricula About Diversity, Equity, Inclusion, and Justice in Undergraduate Medical Education

Curricula in medical education continue to evolve as societal demographics shift and medical innovation transforms the practice of medicine. The next generation of physicians must be well trained, prepared, and adept to provide health care to diverse patient populations. The last few years have witnessed increased awareness about racial and social injustice, with medical institutions acting swiftly to create and implement or enhance curricula about diversity, equity, inclusion, and justice (DEIJ) including topics such as antiracism, bias, cultural humility and sensitivity, and health care disparities and inequities. In this review article, we highlight the incorporation of DEIJ into undergraduate medical education with a focus on the standards provided by the Liaison Committee on Medical Education. We draw on examples of enacted and revised DEIJ curricula in medical education including student activism, clinical electives at pediatric residency programs targeting historically underrepresented in medicine (UIM) students, and community building for UIM students through participation in professional affinity organizations. The article also addresses current state legislation that could affect medical student learning about DEIJ and patient care. [ Pediatr Ann . 2023;52(7):e249–e255.]

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.

EDITORIAL COMMENT

The authors of this paper must be commended for attempting to answer a difficult question given limited data. The question was as follows: are there differences in the number of publications by Under Represented in Medicine (URiM) residents and faculty compared to their peers as well as by women compared to their peers? While this is an important question as it has ramifications for academic advancement, the methodology employed is concerning. Although the authors are intentional about acknowledging the problematic nature of how URiM status was obtained, this point warrants further highlighting. In this study, race was determined by origin of name, photo, biography and employing social media sources. Race is an indistinct socio-political construct that aggregates people into groups based on perceived differences. Particularly in the United States, a country with a contentious history regarding race, where policies such as the one-drop-rule were codified by law, using photos to establish identity erases the complexity of racial identity for those who may be, for example, White-appearing, but culturally identify as another race or ethnicity. In order to minimize the harm and burden that stereotyping may introduce, research that employs race as a classification variable, should use self-reported race rather than assigned. 1 Ioannidis J.P.A. Powe N.R. Yancy C. Recalibrating the use of race in medical research. JAMA - J Am Med Assoc. 2021; 325https://doi.org/10.1001/jama.2021.0003 Google Scholar ,2 Lu C. Ahmed R. Lamri A. Anand S.S. Use of race, ethnicity, and ancestry data in health research. PLOS Glob Public Heal. 2022; 2https://doi.org/10.1371/journal.pgph.0001060 Google Scholar The authors endeavored to validate their method by corroborating the race of 89 faculty members whose self-identified race was known, however it is unclear if this is an adequate sample size to detect a difference in the population of 2131 faculty members included in the study. We will therefore focus the remainder of the commentary on the findings pertaining to differences between women and men urologists.

EDITORIAL COMMENT

The authors have written a thoughtful article looking at the difference in academic productivity with regards to urologists who are underrepresented in medicine (URM) and women. Their findings show that that URM urologists (trainees and faculty) have similar academic productivity. Women, however, had fewer publications compared to men at all career stages. The findings show gender discrepancies in productivity, which adds to a growing body of literature showing that women could benefit from targeted sponsorship and academic opportunity. Explanation of Data Standards for Race, Ethnicity, Sex, Primary Language, and Disability. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=54