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ImportanceSurgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists.ObjectiveTo examine how NIH funding has been awarded to surgeon-scientists over time.Design, Setting, and ParticipantsThis cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022.Main OutcomeNational Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties.ResultsBetween 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P P Conclusion and RelevanceThis study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.

This study examines trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income.

ImportanceClosing the diversity gap is critical to ensure equity in medical education and health care quality. Nevertheless, evidence-based strategies and best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood and underused. To improve the culture of DEI in graduate medical education (GME), in 2020 the Accreditation Council of Graduate Medical Education (ACGME) launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion Award to recognize exceptional DEI efforts in US residency programs.ObjectiveTo identify strategies and best practices that exemplary US GME programs use to improve DEI.Design and SettingThis qualitative study performed an exploratory content analysis of award applications submitted to the ACGME over 2 cycles in 2020 and 2021, using the constant comparative method. The research team first acknowledged their own biases related to DEI, used caution to not overinterpret the data, and performed several cross-checks during data analysis to ensure confirmability of the results. A preliminary codebook was developed and used during regular adjudication sessions. Disagreements were discussed until agreements were reached.Main Outcomes and MeasuresFoundational (ie, commonly cited, high-impact, and small-effort strategies considered achievable by all programs) and aspirational (ie, potential for high impact but requiring greater effort and investment) DEI strategies used by exemplary GME programs.ResultsThis qualitative study included 29 award applications submitted between August 17, 2020, and January 11, 2022. Strategies spanned the education continuum from premedical students through faculty. Foundational strategies included working with schools, community colleges, and 4-year college campuses; providing structured support for visiting students; mission-driven holistic review for admissions and selection; interviewer trainings on implicit bias mitigation and on how racism and discrimination impact admission processes and advancement; interview-day DEI strategies; inclusive selection and DEI committees; mission statements that include DEI; and retention efforts to improve faculty diversity. Aspirational strategies included development of longitudinal bidirectional collaborations (eg, articulation agreements, annual workshops, funded rotations and/or research) with organizations working with applicants who were historically excluded and underrepresented in medicine, blinding metrics in residency applications, longitudinal curricula on DEI and health equity, and faculty mentoring such as affinity groups, mentored research, and joint academic-community recruitments. Findings provide residency program leadership with a menu of options at various inflection points to foster DEI within their programs.Conclusions and RelevanceThe findings of this qualitative study suggest that GME programs might adopt strategies of exemplary programs to improve DEI in residency, ensure compliance with accreditation standards, and improve health outcomes for all.

Microaggressions are an insidious form of racism where members of the white dominant group convey covert hostility towards people of color. Evidence suggests that microaggressions do occur in healthcare education settings, but it relies on ad hoc scales that may limit their generalizability thereby complicating an effort to study and intervene systematically. Data from two national samples of healthcare trainees are leveraged to investigate the factor structure of the HERMS. Exploratory and confirmatory factor analysis supported a nine-item correlated factors structure with two latent factors representing microinvalidations and microinsults. The screener developed in the current study identifies key microaggressions experienced by healthcare trainees of color.

This cross-sectional study examines trends in number of awards and funding of general and diversity F31 predoctoral fellowships from 2001 to 2020.

This cohort study investigates whether different rates of medical student placement into graduate medical education exist by sex, race and ethnicity, and socioeconomic status from 2018 to 2021.

ImportanceSince 1964, the National Institutes of Health (NIH) has funded the Medical Scientist Training Program (MSTP) MD-PhD program at medical schools across the US to support training physician-scientists. Recent studies have suggested that MSTPs have consistently matriculated more students from racial and ethnic backgrounds historically underrepresented in science than MD-PhD programs without NIH funding; however, the underlying basis for the increased diversity seen in NIH-funded MSTPs is poorly understood.ObjectiveTo investigate how administrators and faculty perceive the impact of MSTP status on MD-PhD program matriculant racial and ethnic diversity.Design, Setting, and ParticipantsThis qualitative study used a positive deviance approach to identify 9 high-performing and 3 low-performing MSTPs based on the percentage of students underrepresented in science who matriculated into the program between 2014 and 2018. This study, a subanalysis of a larger study to understand recruitment of students underrepresented in science at MSTPs, focused on in-depth qualitative interviews, conducted from October 26, 2020, to August 31, 2022, of 69 members of MSTP leadership, including program directors, associate and assistant program directors, and program administrators.Main Outcomes and MeasuresThe association of NIH funding with institutional priorities, programs, and practices related to MD-PhD program matriculant racial and ethnic diversity.ResultsThe study included 69 participants (mean [SD] age, 53 [10] years; 38 women [55%]; 13 African American or Black participants [19%], 6 Asian participants [9%], 12 Hispanic participants [17%], and 36 non-Hispanic White participants [52%]). A total of 51 participants (74%) were in administrative roles, and 18 (26%) were faculty involved in recruitment. Five themes emerged from the data: (1) by tying MSTP funding to diversity efforts, the NIH created a sense of urgency among MSTP leadership to bolster matriculant diversity; (2) MD-PhD program leadership leveraged the changes to MSTP grant review to secure new institutional investments to promote recruitment of students underrepresented in science; (3) MSTPs increasingly adopted holistic review to evaluate applicants to meet NIH funding requirements; (4) MSTP leadership began to systematically assess the effectiveness of their diversity initiatives and proactively identify opportunities to enhance matriculant diversity; and (5) although all MSTPs were required to respond to NIH criteria, changes made by low-performing programs generally lacked the robustness demonstrated by high-performing programs.Conclusions and RelevanceThis study suggests that NIH funding requirements may be a powerful incentive to promote diversity and positively affect representation of students underrepresented in science in the biomedical scientific workforce.

BACKGROUND: Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE: To assess US medical students’ experiences of microaggressions and how these experiences influenced students’ mental health and medical school satisfaction. DESIGN AND PARTICIPANTS: We conducted a cross-sectional, online survey of US medical students’ experiences of microaggressions. MAIN MEASURES: The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents’ reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS: Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1–7.9), 3.87 (95% CI: 1.48–11.05), and 9.38 (95% CI: 3.71–26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p

This cross-sectional study assesses the association of mistreatment and discrimination among medical students with attrition from medical school.

Introduction Violent encounters with police represent a significant cause of morbidity and mortality in the USA, especially among Black, Indigenous, and People of Colour (BIPOC). This study characterises trends in fatal police shootings overall and by armed status and quantifies inequities in mortality burden and years of life lost (YLL) across racial/ethnic groups. Methods Longitudinal study of Washington Post data on fatal police shootings in the USA using generalised linear-mixed models to capture trends with time and relative rates. Results This study shows that the rate of fatal police shootings for Black, Indigenous, and People of Colour (BIPOC) is constant from 2015 to 2020. Further, BIPOC have significantly higher death rates compared with Whites in the overall victim pool (Native American RR=3.06, Black RR=2.62, Hispanic RR=1.29) and among unarmed victims (Black RR=3.18, Hispanic RR=1.45). Native American (RR=3.95), Black (overall RR=3.29, unarmed RR=3.49) and Hispanic (RR=1.55, unarmed RR=1.55), victims had similarly high rates of YLL relative to Whites. Conclusion Fatal police shootings are a public health emergency that contribute to poor health for BIPOC. Urgent attention from health professionals is needed to help drive policy efforts that reduce this unjust burden and move us towards achieving health equity in the US.

Supplemental Digital Content is available in the text., Purpose To describe how racial microaggressions may affect optimal learning for under-represented health professions students. Method The authors conducted focus groups and individual interviews from November 2017 to June 2018 with 37 students at University of California, Davis and Yale University who self-identified as underrepresented in medicine or nursing. Questions explored incidence, response to, and effects of racial microaggressions, as well as students’ suggestions for change. Data were organized and coded, then thematic analysis was used to identify themes and subthemes. Results The data showed consistent examples of microaggressions across both health professions and schools, with peers, faculty, preceptors, and structural elements of the curricula all contributing to microaggressive behavior. The 3 major themes were: students felt devalued by microaggressions; students identified how microaggressions affected their learning, academic performance, and personal wellness; and students had suggestions for promoting inclusion. Conclusions The data indicated that students perceived that their daily experiences were affected by racial microaggressions. Participants reported strong emotions while experiencing racial microaggressions including feeling stressed, frustrated, and angered by these interactions. Further, students believed microaggressions negatively affected their learning, academic performance, and overall well-being. This study shows the need for leadership and faculty of health professions schools to implement policies, practices, and instructional strategies that support and leverage diversity so that innovative problem-solving can emerge to better serve underserved communities and reduce health disparities.

ImportanceSurgical diseases account for approximately 30% of the global burden of disease. Gender diversity in biomedical research is critical to generate innovative patient-centered research in surgery.ObjectiveTo examine the distribution of biomedical research funding by the National Institutes of Health (NIH) among women and men surgeon-scientists during a 25-year period.Design, Setting, and ParticipantsThis cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) database for research project grants awarded to women and men surgeon-scientists who were principal investigators between 1995 and 2020. Data were retrieved between January 20 and March 20, 2022. The representation of women surgeon-scientists among academic surgeons was compared with the representation of men surgeon-scientists over time.Main Outcomes and MeasuresDistribution of NIH funding to women and men surgeon-scientists was examined via 2 metrics: holding a large-dollar (ie, R01-equivalent) grant and being a super principal investigator (SPI) with $750 000 or more in total annual research funding. Statistical analysis was performed between April 1 and August 31, 2022.ResultsBetween 1995 and 2020, 2078 principal investigator surgeons received funding from the NIH. The proportion of women academic surgeons who were surgeon-scientists remained unchanged during this same period (1995, 14 of 792 [1.8%] vs 2020, 92 of 3834 [2.4%]; P = .10). Compared with their men counterparts, women surgeon-scientists obtained their first NIH grant earlier in their career (mean [SD] years after first faculty appointment, 8.8 [6.2] vs 10.8 [7.9] years; P Conclusions and RelevanceThe findings of this cross-sectional study of NIH-funded surgeons suggest that women surgeons remained underrepresented among surgeon-scientists over a 25-year period despite early career success in receiving NIH funding. This is concerning and warrants further investigation to increase the distribution of NIH funding among women surgeon-scientists.

ImportanceDiversity in the biomedical research workforce is essential for addressing complex health problems. Female investigators and investigators from underrepresented ethnic and racial groups generate novel, impactful, and innovative research, yet they are significantly underrepresented among National Institutes of Health (NIH) investigators.ObjectiveTo examine the gender, ethnic, and racial distribution of super NIH investigators who received 3 or more concurrent NIH grants.Design, Setting, and ParticipantsThis cross-sectional study included a national cohort of NIH-funded principal investigators (PIs) from the NIH Information for Management, Planning, Analysis, and Coordination (IMPAC II) database from 1991 to 2020.ExposuresSelf-identified gender, race and ethnicity, annual number of NIH grant receipt, career stage, and highest degree.Main Outcomes and MeasuresDistribution of investigators receiving 3 or more research project grants, referred to as super principal investigators (SPIs), by gender, race, and ethnicity.ResultsAmong 33 896 investigators in fiscal year 2020, 7478 (22.01%) identified as Asian, 623 (1.8%) as Black, 1624 (4.8%) as Hispanic, and 22 107 (65.2%) as White; 21 936 (61.7%) identified as men; and 8695 (35.3%) were early-stage investigators. Between 1991 and 2020, the proportion of SPIs increased 3-fold from 704 (3.7%) to 3942 (11.3%). However, SPI status was unequal across gender, ethnic, and racial groups. Women and Black PIs were significantly underrepresented among SPIs, even after adjusting for career stage and degree, and were 34% and 40% less likely than their male and White colleagues, respectively, to be an SPI. Black women PIs were the least likely to be represented among SPIs and were 71% less likely to attain SPI status than White men PIs (adjusted odds ratio, 0.29; 95% CI, 0.21-0.41).Conclusions and RelevanceIn this cross-sectional study of a national cohort of NIH-funded investigators, the gender, ethnic, and racial gaps in receipt of multiple research project grants among NIH investigators was clearly apparent and warrants further investigation and interventions.

COVID-19 vaccine research success and emergency use authorizations (EUAs) have shown the life sciences’ potential for positive health impact. But they also underscore potentially divergent and conf...

ImportancePrevious studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.ObjectiveTo examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.Design, Setting, and ParticipantsThis retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)–accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.Main Outcomes and MeasuresThe primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.ResultsThe study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: −1.27 [0.38]; P P P Conclusions and RelevanceIn this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.

OBJECTIVES: Emergency departments serve a wide variety of racial, ethnic, socioeconomic, and gender backgrounds. It is currently unknown what characteristics of students who express interest in emergency medicine (EM) are associated with a simultaneous desire to work in medically underserved areas. We hypothesize that those who are underrepresented in medicine, are female, learn another language, and have more student debt will be more likely to practice in a medically underserved area. METHODS: Data from the National Board of Medical Examiners, Association of American Medical Colleges (AAMC) Student Record System, and the AAMC Graduation Questionnaire were collected on a national cohort of 92,013 U.S. medical students who matriculated from 2007 through 2012. Extracted variables included planned practice area, intention to practice in underserved areas, race/ethnicity, sex, medical school experiences, age at matriculation, debt at graduation, and first‐attempt USMLE Step 1 score. RESULTS: EM‐intending students who identified as female, non‐Hispanic Black/African American, or Latinx/Hispanic; had a larger debt at graduation; had experiences with health education in the community; had global health experience; and had learned more than one language were more likely to report an intention to practice in underserved areas. CONCLUSION: With the increasing importance of physician diversity to match those of the community being served, this study identifies factors associated with a desire of EM students to work in underserved areas. Medical schools and EM residencies may wish to consider these factors in their admissions process.

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 $48,881 (95% CI $43,799–$54,552), $27,890 (95% CI $25,460–$30,551), and $12,983 (95% CI $12,493–$13,492), respectively. Conclusions The Denver ED TOF Score predicts healthcare resource utilization, and is a useful bedside tool to identify patients early after injury that are likely to require significant healthcare resources and specialized trauma care.

ImportanceDiverse research teams are critical to solving complex health problems and producing high-quality medical research.ObjectiveTo examine the associations of student sex and racial and ethnic identity with publication rates during medical school.Design, Setting, and ParticipantsThis cohort study assessed individual-level data of US MD graduates from medical school who matriculated in academic years 2014 to 2015 and 2015 to 2016. Data were obtained from the Association of American Medical Colleges and analyzed from October 2021 to January 2022.Main Outcomes and MeasuresOutcomes of interest included students’ self-reported participation in unique research experiences, number of publications, and computed publications per research experience. Poisson regressions were constructed to determine the association of sex and racial and ethnic identity with research outcomes using adjusted rate ratios (aRRs).ResultsAmong 31 474 graduates, 15 159 (48.2%) identified as women and 4344 (13.8%) identified as underrepresented in medicine by race and ethnicity (URIM; including American Indian, Alaska Native, Black, Hawaiian Native, Hispanic/Latinx, and Pacific Islander individuals). Students who attended National Institutes of Health (NIH) top 40 research-ranked schools reported higher number of research experiences and publication counts, resulting in a higher publication rate compared with students from non–top 40 schools (median [IQR] 1.60 [1.00-3.00] vs 1.25 [0.50-2.33]; P Conclusions and RelevanceThese findings illustrate that inequities in the physician-scientist workforce began early in training and highlight key areas for intervention, such as funding support and mentorship training during undergraduate medical education, that may promote the future success of a diverse physician-scientist workforce.

Diversity in the medical workforce is critical to improve health care access and achieve equity for resource-limited communities. Despite increased efforts to recruit diverse medical trainees, there remains a large chasm between the racial and ethnic and socioeconomic composition of the patient population and that of the physician workforce.To analyze student attrition from medical school by sociodemographic identities.This retrospective cohort study included allopathic doctor of medicine (MD)-only US medical school matriculants in academic years 2014-2015 and 2015-2016. The analysis was performed from July to September 2021.The main outcome was attrition, defined as withdrawal or dismissal from medical school for any reason. Attrition rate was explored across 3 self-reported marginalized identities: underrepresented in medicine (URiM) race and ethnicity, low income, and underresourced neighborhood status. Logistic regression was assessed for each marginalized identity and intersections across the 3 identities.Among 33 389 allopathic MD-only medical school matriculants (51.8% male), 938 (2.8%) experienced attrition from medical school within 5 years. Compared with non-Hispanic White students (423 of 18 213 [2.3%]), those without low income (593 of 25 205 [2.3%]), and those who did not grow up in an underresourced neighborhood (661 of 27 487 [2.4%]), students who were URiM (Hispanic [110 of 2096 (5.2%); adjusted odds ratio (aOR), 1.41; 95% CI, 1.13-1.77], non-Hispanic American Indian/Alaska Native/Native Hawaiian/Pacific Islander [13 of 118 (11.0%); aOR, 3.20; 95% CI, 1.76-5.80], and non-Hispanic Black/African American [120 of 2104 (5.7%); aOR, 1.41; 95% CI, 1.13-1.77]), those who had low income (345 of 8184 [4.2%]; aOR, 1.33; 95% CI, 1.15-1.54), and those from an underresourced neighborhood (277 of 5902 [4.6%]; aOR, 1.35; 95% CI, 1.16-1.58) were more likely to experience attrition from medical school. The rate of attrition from medical school was greatest among students with all 3 marginalized identities (ie, URiM, low income, and from an underresourced neighborhood), with an attrition rate 3.7 times higher than that among students who were not URiM, did not have low income, and were not from an underresourced neighborhood (7.3% [79 of 1086] vs 1.9% [397 of 20 353]; P .001).This retrospective cohort study demonstrated a significant association of medical student attrition with individual (race and ethnicity and family income) and structural (growing up in an underresourced neighborhood) measures of marginalization. The findings highlight a need to retain students from marginalized groups in medical school.

This cross-sectional study investigates the association between Alpha Omega Alpha (AΩA) honor society membership and medical student socioeconomic status.

This cross-sectional study uses data from the Association of American Medical Colleges’ 2016 and 2017 Medical School Graduation Questionnaire to examine whether medical students’ perceptions of faculty respect for diversity differ by students’ sex, race/ethnicity, sexual orientation, and age., Key Points Question Do medical students’ perceptions of faculty role modeling of respect for diversity vary by students’ demographic characteristics? Findings In this cross-sectional study of 28 778 graduating medical students, 17.7% of students reported perceiving that faculty showed a lack of respect for diversity. Female students, students belonging to racial/ethnic minority groups, and lesbian, gay, or bisexual students disproportionately reported perceiving a lack of respect for diversity among faculty. Meaning The findings suggest that faculty role modeling of respect for diversity is perceived differently by students from marginalized groups., Importance Faculty role modeling is critical to medical students’ professional development to provide culturally adept, patient-centered care. However, little is known about students’ perceptions of faculty role modeling of respect for diversity. Objective To examine whether variation exists in medical students’ perceptions of faculty role modeling of respect for diversity by student demographic characteristics. Design, Setting, and Participants This cross-sectional study analyzed data from the Association of American Medical Colleges’ 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. Main Outcomes and Measures Students’ perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. Results Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). Conclusions and Relevance In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.

Microaggressions are thought to negatively impact learning and mental health in underrepresented (UR) nursing students.The purpose of this study was to investigate three hypotheses in a sample of nursing students: (a) whether, compared to White nursing students, UR nursing students experienced higher frequency of microaggressions, (b) whether microaggressions predict lesser satisfaction with nursing training and (c) whether microaggressions are associated with higher depression screening scores.A survey during Summer 2020 assessed 862 nursing students (71.8% female, Mean age = 28.8, SD = 9.27, 61.4% White, 20.0% UR) on microaggressions, satisfaction with their nursing program, and depression symptoms.We found that compared to White nursing students, UR nursing students reported significantly greater microaggression frequency (with Black students reporting the highest frequency), lesser nursing training satisfaction, and equivalent potential depression rates.Microaggressions deteriorate indicators of wellbeing, especially in UR nursing students. Strategic action to mitigate microaggressions and promote inclusion is needed.

Key Points Question Is there an association between sexual orientation and burnout among US medical students, and is this association mediated by experiences of mistreatment? Findings Cross-sectional surveys of 2016 and 2017 graduating US medical students showed significantly higher rates of perceived mistreatment and burnout symptoms among lesbian, gay, or bisexual (LGB) medical students compared with heterosexual students. Perceived experiences of mistreatment mediated the association between LGB sexual orientation and burnout but did not completely account for excess burnout reported by LGB students. Meaning The findings of this study suggest that medical students in sexual minority groups report increased symptoms of burnout regardless of their perceived experiences of mistreatment., Importance Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. Objective To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. Design, Setting, and Participants This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)–accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. Main Outcomes and Measures Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. Results From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P, This cross-sectional study evaluates whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment.

Despite a lack of intent to discriminate, physicians educated in United States medical schools and residency programs often take actions that systematically disadvantage minority patients. The approach to assessment of learner performance in medical education can similarly disadvantage minority learners. The adoption of holistic admissions strategies to increase the diversity of medical training programs has not been accompanied by increases in diversity in honor societies, selective residency programs, medical specialties, and medical school faculty. These observations prompt justified concerns about structural and interpersonal bias in assessment. This manuscript characterizes equity in assessment as a "wicked problem" with inherent conflicts, uncertainty, dynamic tensions, and susceptibility to contextual influences. The authors review the underlying individual and structural causes of inequity in assessment. Using an organizational model, they propose strategies to achieve equity in assessment and drive institutional and systemic improvement based on clearly articulated principles. This model addresses the culture, systems, and assessment tools necessary to achieve equitable results that reflect stated principles. Three components of equity in assessment that can be measured and evaluated to confirm success include intrinsic equity (selection and design of assessment tools), contextual equity (the learning environment in which assessment occurs), and instrumental equity (uses of assessment data for learner advancement and selection and program evaluation). A research agenda to address these challenges and controversies and demonstrate reduction in bias and discrimination in medical education is presented.

Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents’ perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, internal medicine/primary care, emergency medicine, paediatrics, combined internal medicine/paediatrics and obstetrics/gynaecology. In both pre-tour and post-tour, we asked participants to (1) rank the importance of individual-level and neighbourhood-level factors affecting patients' health, (2) describe strategies used to improve health behaviours and (3) describe knowledge of community resources. Eighty-one physician-residents participated in walks (pre-tour surveys (93% participation rate (n=75)), and post-tour surveys (53% participation rate (n=43)). Pre-tour, the factor ranked most frequently affecting patient health was ‘access to primary care’ (67%) compared with post-tour: ‘income’ (44%) and ‘transportation’ (44%). In describing ways to improve diet and exercise, among pre-tour survey respondents, 67% discussed individual-level strategies and 16% discussed neighbourhood-level, while among post-tour survey respondents, 39% of respondents discussed individual-level strategies and 37% discussed neighbourhood-level. Percentage of respondents aware of community resources changed from 5% to 76% (p