Dowin Boatright

Racial Disparities in Medical Student Membership in the Alpha Omega Alpha Honor Society

Importance Previous studies have found racial and ethnic inequities in the receipt of academic awards, such as promotions and National Institutes of Health research funding, among academic medical center faculty. Few data exist about similar racial/ethnic disparities at the level of undergraduate medical education. Objective To examine the association between medical student race/ethnicity and induction into the Alpha Omega Alpha (A&OHgr;A) honor society. Design, Setting, and Participants This study analyzed data from the Electronic Residency Application Service, the official service used by US medical students to apply to residency programs. A total of 4655 US medical students from 123 allopathic US medical schools who applied to 12 distinct residency programs associated with one academic health center in the 2014 to 2015 academic year were studied. Main Outcomes and Measures Membership in the A&OHgr;A society among black, white, Hispanic, and Asian medical students. Results A total of 4655 unique applications were analyzed in the study (median age, 26 years; 2133 women [45.8%]). Overall, self-reported race/ethnicity in our sample was 2605 (56.0%) white (691 [71.5%] of A&OHgr;A applicants were white), 276 (5.9%) black (7 [0.7%] A&OHgr;A), 186 (4.0%) Hispanic (27 [2.8%] A&OHgr;A), and 1170 (25.1%) Asian (168 [17.4%] A&OHgr;A). After controlling for US Medical Licensing Examination Step 1 scores, research productivity, community service, leadership activity, and Gold Humanism membership, the study found that black (adjusted odds ratio [aOR], 0.16; 95% CI, 0.07-0.37) and Asian (aOR, 0.52; 95% CI, 0.42-0.65) medical students remained less likely to be A&OHgr;A members than white medical students. No statistically significant difference was found in A&OHgr;A membership between white and Hispanic medical students (aOR, 0.79; 99% CI, 0.45-1.37) in the adjusted model. Conclusions and Relevance Black and Asian medical students were less likely than their white counterparts to be members of A&OHgr;A, which may reflect bias in selection. In turn, A&OHgr;A membership selection may affect future opportunities for minority medical students.

Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations

Purpose The transition from medical school to residency is a critical step in the careers of physicians. Because of the standardized application process–wherein schools submit summative Medical Student Performance Evaluations (MSPE’s)–it also represents a unique opportunity to assess the possible prevalence of racial and gender disparities, as shown elsewhere in medicine. Method The authors conducted textual analysis of MSPE’s from 6,000 US students applying to 16 residency programs at a single institution in 2014–15. They used custom software to extract demographic data and keyword frequency from each MSPE. The main outcome measure was the proportion of applicants described using 24 pre-determined words from four thematic categories (“standout traits”, “ability”, “grindstone habits”, and “compassion”). Results The data showed significant differences based on race and gender. White applicants were more likely to be described using “standout” or “ability” keywords (including “exceptional”, “best”, and “outstanding”) while Black applicants were more likely to be described as “competent”. These differences remained significant after controlling for United States Medical Licensing Examination Step 1 scores. Female applicants were more frequently described as “caring”, “compassionate”, and “empathic” or “empathetic”. Women were also more frequently described as “bright” and “organized”. Conclusions While the MSPE is intended to reflect an objective, summative assessment of students’ qualifications, these data demonstrate for the first time systematic differences in how candidates are described based on racial/ethnic and gender group membership. Recognizing possible implicit biases and their potential impact is important for faculty who strive to create a more egalitarian medical community.

Increasing Resident Diversity in an Emergency Medicine Residency Program: A Pilot Intervention With Three Principal Strategies.

PROBLEM Much work remains to be done to align the diversity of the health care workforce with the changing racial and ethnic backgrounds of patients, especially in the field of emergency medicine. APPROACH In academic year (AY) 2012-2013, to increase the number of underrepresented minority (URM) candidates who were interviewed and matched, the Denver Health Residency in Emergency Medicine program (DHREM) initiated a focused pilot intervention with three principal strategies: (1) a scholarship-based externship program, (2) a funded second-look event, and (3) increased involvement and visibility of URM faculty in the interview and recruitment process. OUTCOMES One year after implementation of the pilot intervention, the percentage of URMs among all applicants invited to interview at the DHREM doubled (7.1% [20/282] in AY 2011-2012, 7.0% [24/344] in AY 2012-2013, and 14.8% [58/393] in AY 2013-2014) (95% confidence interval [CI] = 5-10, 4-11, and 11-19, respectively). Of all DHREM interviewees in AY 2013-2014, 17.6% (49/279) (95% CI = 12-23) were URMs, nearly a threefold increase from AY 2012-2013 (6.2% [14/226], 95% CI = 3-10). In AY 2013-2014, 23.5% (4/17) (95% CI = 7-50) of all new DHREM residents were URMs, compared with 5.9% (1/17) in AY 2011-2012 and 5.6% (1/18) in AY 2012-2013 (95% CI = 0-29 and 0-27, respectively). NEXT STEPS Additional studies are needed to determine whether these results are sustainable and generalizable to other residency programs in emergency medicine and other specialties.

Minority Resident Physicians’ Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace

Key Points Question How do minority resident physicians view the role of race/ethnicity in their training experiences? Findings This qualitative study of 27 minority resident physicians found that participants described 3 major themes: a daily barrage of microaggressions and bias, minority residents tasked as race/ethnicity ambassadors, and challenges negotiating professional and personal identity while seen as “other.” Meaning Results of this study suggest that minority residents face extra workplace burdens during a period already characterized by substantial stress, warranting further attention from educators, institutions, and accreditation bodies.

Denver Emergency Department Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients

BACKGROUND Early identification of trauma patients who need specialized healthcare resources may facilitate goal-directed resuscitation and effective secondary triage. OBJECTIVE To estimate associations between Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and healthcare resource utilization. METHODS Retrospective study of adult trauma patients at Denver Health Medical Center. The outcome was resource utilization including: intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures, and costs. Multivariable regression analyses were used to estimate associations between moderate- or high-risk patients, as determined by the Denver ED TOF Score, and healthcare resource utilization. RESULTS We included 3000 patients with a median age of 42 (IQR 27-56) years, 71% male, median injury severity score 9 (IQR 5-16), and 83% blunt mechanism. Among the cohort, 1379 patients (46%) were admitted to the ICU and 122 (4%) died. The adjusted relative risk for high- and moderate-risk as compared to low risk for number of procedures performed was 2.31 (95% CI 2.07-2.57) and 1.80 (95% CI 1.59-2.03) respectively; ICU LOS was 2.87 (95% CI 2.70-3.05) and 1.71 (95% CI 1.60-1.83) respectively; hospital LOS was 3.33 (95% CI 3.21-3.45) and 1.97 (95% CI 1.90-2.05) respectively. The adjusted geometric mean for high-, moderate-, and low-risk for costs was

Racial and Ethnic Diversity in Academic Emergency Medicine: How Far Have We Come? Next Steps for the Future

48,881 (95% CI

Development and testing of shared decision‐making interventions for use in emergency care: A research agenda

43,799-

Current Status of Gender and Racial/Ethnic Disparities Among Academic Emergency Medicine Physicians

54,552),

Clinical Vignettes Inadequate to Assess Impact of Implicit Bias: Concerning Limitations of a Systematic Review

27,890 (95% CI

The Impact of the 2008 Council of Emergency Residency Directors (CORD) Panel on Emergency Medicine Resident Diversity

25,460-