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.

Rates of Medical Student Placement Into Graduate Medical Education by Sex, Race and Ethnicity, and Socioeconomic Status, 2018-2021

Key Points Question Are student sex and racial and ethnic identity associated with publication rate during medical school? Findings This cohort study of 31 474 medical school graduates found a significant disparity in publication rates across sex and race and ethnicity, with women and Black and Hispanic students reporting lower publication rates compared with men and White students. Sex and racial and ethnic disparities in research persisted at both National Institutes of Health top 40 and non–top 40 research-intensive schools. Meaning These findings suggest that inequities in the physician-scientist workforce began early in training, as exposure to research and research productivity are critical for a successful career as a physician-scientist.

/pdf/variation-in-research-experiences-and-publications-during-29qm15v0.pdf

Variation in Research Experiences and Publications During Medical School by Sex and Race and Ethnicity

To dismantle racism in U.S. medical education, people must understand how the history of Christian Europe, Enlightenment-era racial science, colonization, slavery, and racism shaped modern American medicine. Beginning with the coalescence of Christian European identity and empire, the authors trace European racial reasoning through the racial science of the Enlightenment into the White supremacist and anti-Black ideology behind Europe’s global system of racialized colonization and enslavement. The authors then follow this racist ideology as it becomes an organizing principle of Euro-American medicine and examine how it manifests in medical education in the United States today. Within this historical context, the authors expose the histories of violence underlying contemporary terms such as implicit bias and microaggressions. Through this history, they also gain a deeper appreciation of why racism is so prevalent in medical education and how it affects admissions, assessments, faculty and trainee diversity, retention, racial climate, and the physical environment. The authors then recommend 6 historically informed steps for confronting racism in medical education: (1) incorporate the history of racism into medical education and unmask institutional histories of racism, (2) create centralized reporting mechanisms and implement systematic reviews of bias in educational and clinical activities, (3) adopt mastery-based assessment in medical education, (4) embrace holistic review and expand its possibilities in admissions, (5) increase faculty diversity by using holistic review principles in hiring and promotions, and (6) leverage accreditation to combat bias in medical education. These strategies will help academic medicine begin to acknowledge the harms propagated throughout the history of racism in medicine and start taking meaningful steps to address them. Although the authors have focused on racism in this paper, they recognize there are many forms of bias that impact medical education and intersect with racism, each with its particular history, that deserve their own telling and redress. 

The Long Shadow: A Historical Perspective on Racism in Medical Education

OBJECTIVE
To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.


DATA SOURCES AND STUDY SETTING
We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS).


STUDY DESIGN
We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency.


DATA COLLECTION/EXTRACTION METHODS
We merged NGS data with residency type-rural or urban-and practice location with AMCAS data on rural background.


PRINCIPAL FINDINGS
Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees.


CONCLUSIONS
Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.

Growing a rural family physician workforce: The contributions of rural background and rural place of residency training.

All clinicians should provide high-quality, safe, and equitable care to every patient and community. Yet, in practice, health care delivery systems are designed and organized to exacerbate inequity in access and outcomes, and clinicians are incentivized to deliver unequal and inequitable care in deeply segregated academic health centers that are structured to reify white supremacy. This article investigates the nature and scope of health professions educators' obligations to acknowledge harms of segregation in health care as widespread, unjust, iatrogenic, and preventable.

https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2023-01/medu2-2301_0.pdf

Training to Build Antiracist, Equitable Health Care Systems.

Importance
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.


Objective
To analyze student attrition from medical school by sociodemographic identities.


Design, Setting, and Participants
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.


Main Outcomes and Measures
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.


Results
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).


Conclusions and Relevance
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.

Association of Sociodemographic Characteristics With US Medical Student Attrition.

Association of Mistreatment and Discrimination With Medical School Attrition.

Key Points Question What is the current state of social mission commitment in US dental, medical, and nursing schools, and how does social mission performance compare across school types? Findings In this survey study of 689 dental, medical, and nursing schools, public schools performed better than private schools, and doctoral universities classified as having very high research activity (R1) based on the Carnegie Classification of Institutions of Higher Education and special focus institutions performed better than doctoral universities classified as having high (R2) or moderate (R3) research activity and baccalaureate- and master’s degree–granting nursing colleges and universities in several areas of social mission. Different areas of social mission strength emerged for each discipline. Meaning This study’s findings suggest that understanding social mission commitment may aid in developing targeted strategies for enhancing social mission engagement and performance within health professions schools.

Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US

Background
Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas.


Objective
This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work.


Methods
American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program.


Results
Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics.


Conclusions
There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.

Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice.

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Papers

Association of Sociodemographic Characteristics With US Medical Student Attrition.

Association of Mistreatment and Discrimination With Medical School Attrition.

Analysis of Social Mission Commitment at Dental, Medical, and Nursing Schools in the US

Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice.