ABSTRACT

Background

Underrepresented in medicine (UIM) interns have unique lived experiences that affect their paths to medicine, and more information is needed for medical residency and fellowship programs to better support them.

Objective

We describe self-reported differences between UIM and White physician interns in key demographic areas, including household income growing up, physician mentorship, and adverse childhood experiences (ACEs).

Methods

Between 2019 and 2021, we administered a diversity survey to incoming medical interns at the University of Minnesota-Twin Cities. Response rates across the 3 years were 51.2% (167 of 326), 93.9% (310 of 330), and 98.9% (354 of 358), respectively. We conducted analyses to compare UIM and White groups across demographic variables of interest.

Results

A total of 831 of 1014 interns (81.9%) completed the survey. Relative to White interns, UIM interns had lower household incomes growing up, lower rates of mentorship, and higher rates of experiencing 4 or more ACEs. The odds of experiencing the cumulative burden of having a childhood household income of $29,999 or less, no physician mentor, and 4 or more ACEs was approximately 10 times higher among UIM (6.41%) than White (0.66%) interns (OR=10.38, 95% CI 1.97-54.55).

Conclusions

Childhood household income, prior mentorship experiences, and number of ACEs differed between UIM and White interns.

ABSTRACT

Background

Residency program websites have become a central source of information for applicants due to a shift toward virtual interviewing. Applicants, particularly those from diverse backgrounds, place strong value on programs that present commitments to diversity, equity, and inclusion (DEI). The DEI content of residency program websites for primary care specialties has been largely unexplored.

Objective

The objective of this study is to review, in an exploratory manner, family medicine, internal medicine, obstetrics and gynecology, and pediatrics residency program websites for number of DEI elements present. By identifying lacking DEI content, we hope to give residency programs that are seeking to increase diversity among applicants some direction for improving their websites.

Methods

We reviewed all available residency program websites (1814) in the Fellowship and Residency Electronic Interactive Database (FREIDA) from August to December 2021. Each website was evaluated for the presence of 10 DEI elements chosen from previously published website reviews and informal applicant surveys. Some elements included the presence of resident and faculty photos/biographies, patient population descriptions, and dedicated DEI curricula. Program demographic information was collected, and summative statistics were performed.

Results

The average number of DEI elements displayed per program ranged from 3.5 (internal medicine) to 4.9 (pediatrics). The most common elements were resident and faculty photographs/biographies. Internal medicine programs displayed significantly fewer elements than the other 3 specialties. This difference remained significant after controlling for program size, location, and type.

Conclusions

This study highlights a lack of DEI elements available for residency program website visitors to review.

ABSTRACT

Background

Graduate medical education curricula may reinforce systemic inequities and bias, thus contributing to health disparities. Curricular interventions and evaluation measures are needed to increase trainee awareness of bias and known inequities in health care.

Objective

This study sought to improve the content of core noontime internal medicine residency educational conferences by implementing the Department of Medicine Anti-Racism and Equity (DARE) educational initiative.

Methods

DARE best practices were developed from available anti-racism and equity educational materials. Volunteer trainees and faculty in the department of medicine of a large urban academic medical center were recruited and underwent an hourlong training to utilize DARE best practices to coach faculty on improving the anti-racist and equity content of educational conferences. DARE coaches then met with faculty to review the planned 2021-2022 academic year (AY) lectures and facilitate alignment with DARE best practices. A rubric was created from DARE practices and utilized to compare pre-intervention (AY21) and post-intervention (AY22) conferences.

Results

Using the DARE best practices while coaching increased the anti-racism and equity content from AY21 to AY22 (total rubric score mean [SD] 0.16 [1.19] to 1.38 [1.39]; P=.001; possible scores -4 to +5), with 75% (21 of 28) of AY22 conferences showing improvement. This included increased diversity of photographs, discussion of the racial or ethnic makeup of research study participants, appropriate use of race in case vignettes, and discussion of the impact of racism or bias on health disparities.

Conclusions

Training coaches to implement DARE best practices improved the anti-racism and equity content of existing noontime internal medicine residency educational conferences.

The Challenge

Clinician educators (CEs) can feel pressured by multiple institutional forces: compliance with frequently changing Accreditation Council for Graduate Medical Education (ACGME) requirements; the dynamic operational and fiscal strains of sponsoring institutions (SIs); and personal pressures for career advancement, in both academic and community settings. The value of demonstrating contributions as a CE for academic promotion via an annotated curriculum vitae and/or portfolio is well documented.^1,2 However, CEs must also find ways to continuously demonstrate value to program, clinical, and organizational leadership, regardless of the type of SI.

Setting and Problem

The American Medical Association recognizes street homelessness as a significant barrier to the provision of high-quality care.¹ Traditional medical training provides inadequate preparation for physicians to manage persons experiencing unsheltered homelessness (PEUH). Street medicine is the direct provision of health care and social support to PEUH,² who experience high barriers to needed care and tend to use acute hospital-based care at high rates.³

We established a street medicine fellowship to enable physicians to acquire the requisite clinical and organizational skills to become leaders in improving outcomes in this vulnerable population.

Intervention

The