Underrepresented Minorities In Medicine Research Articles

Addressing the gate blocking of minority faculty

There have been ongoing efforts to increase the presence of underrepresented minorities in medicine (URMM), including faculty development initiatives, mentoring programs and outreach efforts. However, URMM faculty face unique challenges that are crucial for academic institutions and leaders to recognize in order to improve retention of this group and allow for meaningful advancement in the field. This paper introduces the concept of gate blocking, defined as what happens to minority faculty as a result of the consequences of the minority tax and systems designed to advantage some and disadvantage others. In addition to defining gate blocking, the authors make recommendations to address this concern in academic medicine and promote the advancement and retention of URMM faculty.

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

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

Seeking racial and ethnic equity among neonatologists.

ObjectiveRacial and ethnic inequities in leadership achievement, compensation, scholarly productivity, and grant funding exists among physicians. This study explores whether similar inequities exist among neonatologists within the United States.Study designA voluntary anonymous survey was distributed to members of the American Academy of Pediatrics Section on Neonatal–Perinatal Medicine with 560 respondents. Logistic regression and ordinary least squares were used to assess whether racial and ethnic identity is associated with clinical time, leadership, compensation, publication, grant funding, or academic rank.ResultsAs compared to non-Hispanic White neonatologists, statistical differences were found for underrepresented minorities in medicine in: regions of the country where they worked, total cash compensation received, being awarded an NIH grant, and location of graduate medical education. Fewer differences were found for Asian neonatologists and included location of graduate medicine education.ConclusionRacial and ethnic identity remains a significant independent factor influencing professional achievement and compensation.

Racial/Ethnic Differences in Burnout: a Systematic Review.

BackgroundAwareness of burnout and its implications within the medical field has been growing. However, an understanding of the prevalence and consequences of burnout among underrepresented minority (URM), specifically underrepresented minority in medicine (UiM) populations, is not readily available.ObjectiveTo examine literature investigating burnout among UiM compared to non-UiM, with particular attention to which measures of burnout are currently being used for which racial/ethnic groups.MethodsThe authors identified peer-reviewed articles, published in English through systematic examination using PubMed, PsycINFO, Countway Discovery Medicine, and Web of Science databases. Studies meeting the inclusion criteria were summarized and study quality was assessed.ResultsSixteen studies assessing racial/ethnic differences in burnout were eligible for inclusion. Nearly all studies were cross-sectional (n = 15) in design and conducted among populations in North America (n = 15). Most studies examined burnout among medical students or physicians and used the Maslach Burnout Inventory. Differences in burnout among UiM and non-UiM are inconclusive, although several studies have nuanced findings.ConclusionIncreased focus on burnout measurement, conceptualization, and mitigation among UiM populations may be useful in improving recruitment, retention, and thriving.

Bridging the gap: improving CASPer test confidence and competency for underrepresented minorities in medicine through interactive peer-assisted learning.

BackgroundThe Computer-based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgement test (SJT) adopted by medical schools to assess applicants’ interpersonal skills. CASPer applicants must compose their responses to ethical dilemmas, thereby highlighting the applicant’s rationale for ethical decision-making. Minority applicants usually lack access to a network of individuals who can offer guidance and expertise on ethical decision-making. As such, this study investigated the impact of a CASPer coaching program designed for minority applicants.MethodsA free online intervention was designed to help minority applicants prepare for the CASPer test. The program consisted of 35 learners and three medical student tutors. Important attributes of the 4-week program included free access to a medical ethics book, feedback provision to in-class and homework student responses, and facilitation of a mock CASPer. Course feedback was collected. Additionally, a pre and post-program survey was administered to assess learners’ competence and confidence surrounding CASPer test-taking.ResultsOur pre and post-program survey showed significant student improvement in familiarity with the test, increased competence, confidence and preparedness, as well as reduced anxiety (p < 0.05).ConclusionsThrough peer-to-peer teaching and access to medical student mentors, our program addresses socioeconomic barriers that several minority applicants face when applying to medical school.

What Will It Take to Recruit and Train More Underrepresented Minority Physicians in Family Medicine? A CERA Survey Analysis.

Both the Society of Teachers of Family Medicine (STFM) and the American Academy of Family Physicians have developed strategic plans to increase the training of underrepresented minority in medicine (URMM) family physicians to meet the needs of an increasingly diverse patient population in the United States. This study examines data from the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Program Directors (PD12) Survey to assess whether recruitment strategies increase the diversity of underrepresented minority physicians in family medicine. Data were collected from an online electronic survey administered by the CERA of family medicine program directors in 2018. The data included specific questions about the diversity of URMM residents in family medicine programs and about initiatives that were used in their recruitment. We analyzed the data using the Pearson χ2 criteria for cause and effect of two variables. Family medicine residency programs that have initiatives dedicated to increasing resident diversity have a higher percentage of URMM residents. Specifically, residency programs that have URMM recruitment strategies are 2.5 to 4 times more likely to have a diverse residency population than those programs without strategies (P&lt;.001-.015). Striving to improve diversity in family medicine residency training in accordance with the ideals of STFM will require programs to design and implement initiatives to increase recruitment of URM residents.

87. OPPORTUNITIES FOR MITIGATING BIAS IN THE PROCESS AND PRIORITIES FOR PEDIATRIC CHIEF RESIDENT SELECTION

Background The number of residents who self-identify as underrepresented minorities in medicine (URM) is low, and this pipeline becomes even leakier as training progresses, with URM rates at 8.7% for academic pediatric faculty in the US. Chief residents (CR) potentially have an advantage in securing academic positions and play a vital role in recruitment and education of residents. It is unknown what the current URM representation in CRs is and what strategies are used to recruit and select more chief residents who are URM. Methods An online survey was developed by pediatric PDs/APDs with content expertise and piloted with active pediatric PDs. Questions focused on resident and CR demographics and processes and priorities for CR selection. It was IRB and APPD-approved and distributed to all pediatric PDs in late 2019. Summary statistics were used to report the percent of CRs who identify with underrepresented groups, characteristics of CR position, whether formal criteria for CR selection are used, and identification of the people who have influence on selection. We will conduct a content analysis of written comments of PD priorities in CR selection. Results The survey was sent out three times, with final data expected in mid-January. 79 of 198 (40%) PDs have responded to date. Preliminary analysis indicates that 18% of residents identify as URM, compared with 15% of PD and APD leadership and 15% of CRs. The average number of CRs per program is 2.4, with a range of 1-4 per year. Only 6% of CRs are paid a faculty salary. No programs report using USMLE scores in the selection of CRs, but 24% use ITE results. 17% report having a specific method to mitigate bias in CR selection. Conclusions The anticipated insights into the demographics and potential sources of bias in the process and priorities for chief resident selection are relevant to PDs, CRs, all APPD members, and other stakeholders outside of APPD, including leadership in UME and governing bodies in pediatrics, who are invested in improving URM representation in academic pediatrics at the resident and faculty levels.

Diversity by Race, Ethnicity, and Sex within the US Psychiatry Physician Workforce.

This study assessed the distribution of race, ethnicity, and sex within the US psychiatry physician workforce and trends from 1987 to 2016. The authors used physician workforce data to assess differences in race, ethnicity, and sex among psychiatric practicing physicians, faculty, fellows, residents, residency applicants, and medical graduate cohorts. Binomial tests were used for comparison between individual cohorts and to US population statistics. A simple linear regression model was used to assess trends among psychiatric residents and faculty over years 1987-2016. Within psychiatry, historically underrepresented minorities in medicine (URMs) had less representation as residents (16.2%), faculty (8.7%), and practicing physicians (10.4%) compared with the US population (32.6%), Ps < 0.0001. Females were underrepresented as psychiatric practicing physicians (38.5%, P < .0001). There was greater URM representation among residents (16.2%) compared with that of Psychiatry faculty and practicing physicians (Ps < .0001). Racial/ethnic representation did not differ significantly compared with subspecialty fellows; however, the addiction subspecialty contained the least URM and female diversity. Historical trends indicated the proportion of female faculty (0.9%/yr) increased nearly 1.5 times faster than that of female trainees (0.6%/year). Conversely, the proportion of URM residents (0.26%/year) increased over 4 times faster than that of URM faculty (0.06%/year), with black faculty actually decreasing in proportion. Female and URM representation within the psychiatry physician workforce is significantly lower than US population demographics; however, trends indicate diminishing underrepresentation. While psychiatry residency remains more diverse than other specialties, specific trends identify poor minority representation among psychiatry faculty and fellows as areas needing attention.

"It's a Little Different for Men"-Sponsorship and Gender in Academic Medicine: a Qualitative Study.

Women remain underrepresented in top leadership positions in academic medicine. In business settings, a person with power and influence actively supporting the career advancement of a junior person is referred to as a sponsor and sponsorship programs have been used to diversify leadership. Little is known about how sponsorship functions in academic medicine. To explore perceptions of sponsorship and its relationship to gender and career advancement in academic medicine. Qualitative study using semi-structured, one-on-one interviews with sponsors and protégés. Twelve sponsors (clinical department chairs) and 11 protégés (participants of a school of medicine executive leadership program [N = 23]) at the Johns Hopkins School of Medicine. All sponsors were men and all were professors, six of the 11 protégés were women, and four of the 23 participants were underrepresented minorities in medicine. We identified three themes: (1) people (how and who): women seek out and receive sponsorship differently; (2) process (faster and further): sponsorship provides an extra boost, especially for women; and (3) politics and culture (playing favorites and paying it forward): sponsorship and fairness. Informants acknowledge that sponsorship provides an extra boost for career advancement especially for women. Sponsors and protégés differ in their perceptions of how sponsorship happens. Informants describe gender differences in how sponsorship is experienced and specifically noted that women were less likely to actively seek out sponsorship and be identified as protégés compared to men. Informants describe a tension between sponsorship and core academic values such as transparency, fairness, and merit. Sponsorship is perceived to be critical to high-level advancement and is experienced differently by women. Increased understanding of how sponsorship works in academic medicine may empower individual faculty to utilize this professional relationship for career advancement and provide institutions with a strategy to diversify top leadership positions.

The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross-sectional study.

Background and AimsUnited States Medical Licensing Exam (USMLE) scores are the single, most objective criteria for admission into residency programs in the country. Underrepresented minorities in medicine (URiM) are found to have lower USMLE scores compared to their White counterparts. The objective of this study is to examine how USMLE step 1 cutoff scores may exclude self‐reported URiM from the residency interview process across various specialties.MethodsThis was a retrospective cross‐sectional study of 10 541 applicants to different residency programs at Zucker School of Medicine at Hofstra/Northwell Health between May 2014 and May 2015. We identified Blacks and Hispanics as URiM. The primary outcome is the percentage of applicants with USMLE step 1 score above different ranges of cutoff score, from 205 to 235 in five‐point increments, by race/ethnicity and by URiM status. Secondary outcome is percentages of URiM vs non‐URiM above and below mean USMLE step 1 scores by different specialties (internal medicine, obstetrics/gynecology, pediatrics, and psychiatry).ResultsThe study sample included 2707 White, 722 Black, 805 Hispanic, 5006 Asian, and 562 Other Race/Ethnicity applicants. Overall, 50.2% were male, 21.3% URiM, 7.4% had limited English proficiency, 67.6% attended international medical schools, and 2.4% are Alpha Omega Alpha Honor Medical Society (AOA) members. The mean (±SD) USMLE step 1 score was significantly greater among non‐URiM applicants as compared to URiM applicants (223.7 ± 19.4 vs 216.1 ± 18.4, P < .01, two‐sample t‐test). Non‐URiM applicants were younger, and the percentage of male and AOA applicants was greater among non‐URiM applicants as compared to URiM applicants (50.5% vs 47.7%, P = .02, Chi‐Square test; 2.9% vs 1.2%, P < .01, Chi‐Square test, respectively).ConclusionUsing a USMLE step 1 cutoff score as an initial filter for applicant recruitment and selection could jeopardize the benefits of a diverse residency program. Practical implications are discussed.

Mission Drift: Are Medical School Admissions Committees Missing the Mark on Diversity?

Diversity initiatives in U.S. medical education, following the passage of the Civil Rights Act of 1964, were geared toward increasing the representation of African Americans-blacks born in the United States whose ancestors suffered under slavery and Jim Crow laws. Over time, blacks and, subsequently, underrepresented minorities in medicine (URMs), became a proxy for African Americans, Puerto Ricans, Mexican Americans, and Native Americans, thus obscuring efforts to identify and recruit specifically African Americans. Moreover, demographic shifts resulting from the recent immigration of black people from Africa and the Caribbean have both expanded the definition of "African American medical students" and shifted the emphasis from those with a history of suffering under U.S. oppression and poverty to anyone who meets a black phenotype.Increasingly, research indicates that African American patients fare better when their physicians share similar historical and social experiences. While all people of color risk discrimination based on their skin color, not all have the lived experience of U.S.-based, systematic, multigenerational discrimination shared by African Americans. In the high-stakes effort to increase URM representation in medical school classes, admissions committees may fail to look beyond the surface of phenotype, thus missing the original intent of diversity initiatives while simultaneously conflating all people of color, disregarding their divergent historical and social experiences. In this Perspective, the authors contend that medical school admissions committees must show greater discernment in their holistic reviews of black applicants if historical wrongs and continued underrepresentation of African Americans in medicine are to be redressed.

Addressing the Minority Tax: Perspectives From Two Diversity Leaders on Building Minority Faculty Success in Academic Medicine

This Invited Commentary explores disparities in academic medicine, known as the minority tax, through the careers of 2 men in senior positions, who are underrepresented minorities in medicine (URMMs), with the goal of sharing real-world experiences that other URMM faculty can use to their benefit. The authors use their lived experiences to document the realities of various aspects of the minority tax (i.e., isolation, mentorship, diversity efforts, and clinical assignments) and introduce a new aspect of the minority tax that has affected both of their inner decision-making processes and personal ambitions: the gratitude tax. By sharing these experiences, the authors are also able to recognize individual mentors and sponsors as well as changes in their knowledge, skills, and attitudes that affected their ability to accomplish career goals, leading to their current academic positions. Sharing experiences is a meaningful way of providing examples for other URMM faculty to follow, as well as illustrating ways in which senior leadership can help mitigate the effect of the minority tax on URMM faculty, thereby increasing equity in academic medicine.

Supporting underrepresented minority women in academic dermatology.

The lack of underrepresented minorities in medicine (UIM) in dermatology has been well established, but the challenges faced by UIM women in dermatology have not yet been explored. UIM women belong simultaneously to more than one underrepresented group and therefore face complex challenges that are common to women and underrepresented minorities. Yet, the literature that focuses explicitly on UIM women as a group is scarce. This commentary provides insight into some of the challenges faced by UIM women in academic dermatology and provides specific recommendations to support these women through mentorship, professional development, and legitimization of their contributions to institutional diversity and service efforts.

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

Introduction: Language concordance between doctors and patients and increased matriculation of underrepresented minorities in medical school are commonly cited goals of medical centers and medical schools in addressing health disparities for individuals with limited English proficiency. Pre-medical education may represent a high-yield untapped opportunity to address both through a Spanish Health Topics, or Temas de Salud, course for Latino pre-health students. Methods: The authors implemented a longitudinal course for pre-health, Latino, undergraduate students to prepare them for success in bilingual health careers. The course included educational components of health knowledge, Spanish terminology, Hispanic/Latino sociocultural context, and exposure to medical learning formats presented during monthly sessions spread out over two years. A post-course survey with comfort and knowledge assessments was administered after each one-year cycle of the program. Results: One hundred and sixteen students (57%) out of 203 course-participants responded to the Spanish Health Topics course survey. The student comfort level and self-perceived knowledge about specific health issues increased for both students of native-level Spanish and less advanced fluency, though a larger improvement was noted in several health topics for native speakers. Eighty-five percent of students reported perceiving the class to be useful for their future careers, and 92% of respondents indicated having applied learned concepts in social and/or academic settings outside of class.Discussion: Most students reported benefits of the course. Future studies should focus on a more detailed evaluation of enrolled students’ knowledge, attitudes, confidence, and long-term retention compared to students in a standard premedical path. Temas de Salud may enhance the bilingual, bicultural skillset of Latino underrepresented minorities in medicine, and can be replicated at other institutions.

Why Residents Quit: National Rates of and Reasons for Attrition Among Emergency Medicine Physicians in Training.

IntroductionRecruiting and retaining residents who will complete their emergency medicine (EM) training is vital, not only because residency positions are a limited and costly resource, but also to prevent the significant disruptions, increased workload, and low morale that may arise when a resident prematurely leaves a program. We investigated national rates of EM resident attrition and examined the reasons and factors associated with their attrition.MethodsIn this retrospective, observational study we used national data from the American Medical Association National Graduate Medical Education Census for all residents who entered Accreditation Council for Graduate Medical Education-accredited EM programs between academic years 2006–2007 and 2015–2016. Our main outcome was the annual national rate of EM resident attrition. Secondary outcomes included the main reason for attrition as well as resident factors associated with attrition.ResultsCompared to the other 10 largest specialties, EM had the lowest rate of attrition (0.8%, 95% confidence interval [CI] [0.7–0.9]), or approximately 51.6 (95% CI [44.7–58.5]) residents per year. In the attrition population, 44.2% of the residents were women, a significantly higher proportion when compared to the proportion of female EM residents overall (38.8%, p=0.011). A greater proportion of Hispanic/Latino (1.8%) residents also left their programs when compared to their White (0.9%) counterparts (p<0.001). In examining reasons for attrition as reported by the program director, female residents were significantly more likely than male residents to leave due to “health/family reasons” (21.5% vs 9.6%, p=0.019).ConclusionWhile the overall rate of attrition among EM residents is low, women and some under-represented minorities in medicine had a higher than expected rate of attrition. Future studies that qualitatively investigate the factors contributing to greater attrition among female and some ethnic minority residents are necessary to inform efforts promoting inclusion and diversity within the specialty.

Design, Implementation, and Evaluation of a Diversity Program for Radiology

Rationale and ObjectivesDiagnostic radiology training programs are less diverse than graduating US medical school classes and the patient populations they serve. Inclusion of physicians who are underrepresented minorities in medicine (URMM) can strengthen the profession and help to meet the needs of an increasingly diverse population. Our Department of Radiology developed and implemented a plan to increase the number of URMMs in our residency applicant pool and residency training program. Materials and MethodsWe designed a recruitment strategy to diversify the radiology residency applicant pool. This included website development, advertising, early exposure opportunities, travel to predominantly minority institutions and national meetings, and mentoring URMM medical students. We implemented parallel activities to increase the number of URMMs in our residency program. These included holistic screening tools for residency application review, a diverse residency recruitment committee, a welcome environment for visiting candidates, and “Second Look Weekend” visits for talented candidates. Primary outcomes measured include change in percentages of URMM applicants in our applicant pool and URMM residents in our residency program. ResultsThe percentage of URMM radiology residency applicants increased from 7.5% (42 of 556) of the total applicant pool in the 2012 to 2013 recruitment year to 12.6% (98 of 777) in the 2017 to 2018 recruitment year (P = .001). URMM radiology residency representation increased from 0% (0 of 32) in the 2013 to 2014 academic year to 20% (6 of 30) in the 2018 to 2019 academic year (P = .01). ConclusionAn intentional, strategic diversity program can diversify an institution’s residency applicant pool and increase representation of URMMs in a diagnostic radiology residency program.

Stat! An Action Plan for Replacing the Broken System of Recruitment and Retention of Underrepresented Minorities in Medicine

Stat! An Action Plan for Replacing the Broken System of Recruitment and Retention of Underrepresented Minorities in Medicine

Improving Underrepresented Minority in Medicine Representation in Medical School.

Despite the efforts of various leading organizations in medical education, representation of black students in US medical schools has declined since the mid-1990s. The Florida State University College of Medicine (FSUCOM) has undertaken efforts to increase black and other underrepresented minority in medicine (URMM) representation in medical school through the Bridge to Clinical Medicine Program. This program is described and analyzed by the authors. Demographic information, Medical College Admission Test scores, undergraduate grade point average, US Medical Licensing Examination (USMLE) scores (Steps 1 and 2), residency match information, and current practice location from 2006 to 2015 were collected from the FSUCOM. Data were analyzed using SAS and linear regression analyses were performed, comparing Bridge students with the College of Medicine and national averages. Sixty percent of Bridge students were black, 21% were other URMM, and the remainder were non-URMM. Black Bridge students scored 7.4 points lower on their Medical College Admission Test, and other-URMM Bridge students scored 6.0 points lower (P < 0.0001) than their non-URMM non-Bridge classmates. Black Bridge students also started with a grade point average that was 0.28 points lower than their non-URMM non-Bridge counterparts, but there was no statistical difference for other-URMM Bridge students. Black students, regardless of Bridge participation, were less likely to pass USMLE Step 1 when compared with non-URMM classmates (P < 0.0001). For USMLE Step 2, however, there were no significant differences in passing rates for Bridge students compared with non-Bridge students. The FSUCOM Bridge program has not only increased its URMM enrollment but it also has effectively doubled the number of black students in its medical college. Other universities could produce similar results using the program outlined in this article.

Session 417 - No Longer Invisible: The Role of International Medical Graduates (IMGS) and Physicians from Underrepresented Minorities in Medicine (URMS) in Geriatric Psychiatry

Session 417 - No Longer Invisible: The Role of International Medical Graduates (IMGS) and Physicians from Underrepresented Minorities in Medicine (URMS) in Geriatric Psychiatry

Fellowship Expands Behavioral Health Care Where Needed the Most

Fellowship Expands Behavioral Health Care Where Needed the Most