Racism in Medical Education, GME

One of the strongest signifiers of cultural validity, particularly in more liberal leaning circles, is when NPR covers your story. Which is to say, NPR posted a story today about racism in medical training, so it’s possible that these messages are filtering up to leadership in academic medicine.

To underscore the importance that Anthony Chin-Quee, MD, is far from alone, here is a short collection of evidence on graduate medical education (GME), i.e. residency and fellowship (recent articles, plus a few older to again remind ourselves that we are not discussing a new situation, but one that has been ongoing, i.e. how racism operates).

Martinez-Strengel A, Balasuriya L, Black A, Berg D, Genao I, Gross CP, Keene D, Latimore D, Sotto-Santiago S, Boatright D. Perspectives of internal medicine residency program directors on the Accreditation Council for Graduate Medical Education (ACGME) diversity standards. J Gen Intern Med. 2021 Sep;36(9):2539-2546.

de Bourmont SS, Burra A, Nouri SS, et al. Resident Physician Experiences With and Responses to Biased Patients. JAMA Netw Open. 2020;3(11):e2021769. doi:10.1001/jamanetworkopen.2020.21769

Jarman BT, Borgert AJ, Kallies KJ, et al. Underrepresented minorities in general surgery residency: Analysis of interviewed applicants, residents, and core teaching faculty. J Am Coll Surg. 2020;231(1):54-58. doi:10.1016/j.jamcollsurg.2020.02.042

Williams M, Kim EJ, Pappas K, et al. 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. Health Sci Rep. 2020;3(2):e2161.

Yuce TK, Turner PL, Glass C, et al. National evaluation of racial/ethnic discrimination in US surgical residency programs. JAMA Surg. 2020;155(6):526-528. doi:10.1001/jamasurg.2020.0260

Dyrbye L, Herrin J, West CP, et al. Association of racial bias with burnout among resident physicians. JAMA Netw Open. 2019;2(7):e197457. doi:10.1001/jamanetworkopen.2019.7457

Jarman BT, Kallies KJ, Joshi ART, et al. Underrepresented minorities are underrepresented among general surgery applicants selected to interview. J Surg Educ. 2019;76(6):e15-e23. doi:10.1016/j.jsurg.2019.05.018 https://pubmed.ncbi.nlm.nih.gov/31175064/

Agawu A, Fahl C, Alexis D, et al. The influence of gender and underrepresented minority status on medical student ranking of residency programs. J Natl Med Assoc. 2019;111(6):665-673. doi:10.1016/j.jnma.2019.09.002

Khan NR, Taylor CM 2nd, Rialon KL. Resident perspectives on the current state of diversity in Graduate Medical Education. J Grad Med Educ. 2019;11(2):241-243. doi:10.4300/JGME-D-19-00062.1

Osseo-Asare A, Balasuriya L, Huot SJ, et al. Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Netw Open. 2018;1(5):e182723. doi:10.1001/jamanetworkopen.2018.2723

Lightfoote JB, Fielding JR, Deville C, et al. Improving diversity, inclusion, and representation in radiology and radiation oncology part 2: challenges and recommendations. J Am Coll Radiol. 2014;11(8):764-770. doi:10.1016/j.jacr.2014.03.008

Yehia BR, Cronholm PF, Wilson N, et al. Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds. BMC Med Educ. 2014;14:26. doi:10.1186/1472-6920-14-26

Liebschutz JM, Darko GO, Finley EP, Cawse JM, Bharel M, Orlander JD. In the minority: black physicians in residency and their experiences. J Natl Med Assoc. 2006;98(9):1441-1448. https://pubmed.ncbi.nlm.nih.gov/17019911/

Edmond MB, Deschenes JL, Eckler M, Wenzel RP. Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews. Acad Med. 2001;76(12):1253-1256. doi:10.1097/00001888-200112000-00021

Recommendations:

Gonzaga AMR, Appiah-Pippim J, Onumah C, Yialamas M. A framework for inclusive Graduate Medical Education recruitment strategies: Meeting the ACGME standard for a diverse and inclusive workforce. Acad Med. 2020; 95(5) 710-716 doi: 10.1097/ACM.0000000000003073

Castillo EG, Isom J, DeBonis KL, Jordan A, Braslow JT, Rohrbaugh R. Reconsidering systems-based practice: Advancing structural competency, health equity, and social responsibility in Graduate Medical Education. Acad Med. doi: 10.1097/ACM.0000000000003559

p.s. Check out this list for a brief review of undergraduate medical education (UME)