Faculty Bibliography

BACKGROUND:Despite prevalent gender discrimination in medical education, its influence on personal and professional development, foundational competencies in medical training per the Association of American Medical Colleges (AAMC), remains unclear. This retrospective cross-sectional study assesses how experiences of gender discrimination in medical school influence personal and professional identity formation (PPIF) among males and females. METHODS:Deidentified student-level data were procured from the AAMC data warehouse for 37,610 MD students who matriculated in 2014-2015 and took the Graduation Questionnaire (GQ) between 2016-2020. Gender discrimination frequency was categorized as 'Never', 'Isolated', and 'Recurrent' from GQ responses to questions about denial of opportunities, offensive remarks, and lower evaluations due to gender. Students self-reported their sex as male, female or declined to answer. PPIF was assessed using two separate GQ metrics assessing student agreement on a 5-point Likert scale that their medical school fostered and nurtured their development as a person and a future physician, respectively, and dichotomized. RESULTS:Female students experienced higher rates of isolated (12.6%) and recurrent (20.1%) gender discrimination than males (4.3% isolated, 6.2% recurrent). Females reported slightly lower personal (71.2%) but similar professional development (92.2%) rates compared to males (73.4% personal, 91.2% professional). Both sexes experiencing gender discrimination had lower likelihoods of PPIF than their counterparts without these experiences. If recurrent discrimination occurred, the aRR (95%CI) of professional development was 0.89 (0.87-0.90) for females and 0.78 (0.74-0.81) for males, while for personal development, it was 0.69 (0.67-0.71) for females and 0.61 (0.58-0.66) for males. Compared to females, males showed sharper declines in professional development as discrimination frequency increased from never to isolated (aRR = 0.93, 95% CI [0.92-0.94], p < 0.001) and isolated to recurrent (aRR = 0.95, 95% CI [0.93-0.97], p < 0.001). CONCLUSIONS:Gender discrimination negatively influences PPIF for both female and male medical students. Efforts to combat discrimination in medical training and promote holistic student development should be considered. Future work is needed to understand the influence of gender discrimination on the comprehensive development of gender-diverse medical students.

IMPORTANCE/OBJECTIVE:With the transition of USMLE Step 1 to pass/fail, USMLE Step 2 Clinical Knowledge (CK) has become a high-stakes component of residency selection. This shift raises concerns that increased reliance on Step 2 CK may exacerbate existing inequities, particularly for medical students with disabilities and those with intersecting marginalized identities. OBJECTIVE:To examine differences in USMLE Step 2 CK performance by disability status, race, ethnicity, and their intersections among U.S. medical students. METHODS:We conducted a cross-sectional analysis of the Pathways II dataset, comprising deidentified student-level data from nine U.S. MD-granting medical schools. Graduated students from the 2020-2023 cohorts were included. Medical students with disabilities were defined as those formally registered with institutional disability resource offices and were matched 1:2 with nondisabled peers by institution, gender, graduation cohort, and MCAT score. Race and ethnicity were categorized as White, Asian, underrepresented in medicine (URiM, including American Indian/Alaska Native, Black/African American, Hispanic/Latino, and Native Hawaiian/Pacific Islander), or Other. Disability categories included ADHD, learning, psychological, mobility/sensory, chronic health, or other. Multivariable linear regression models estimated adjusted Step 2 CK score differences by disability status, race, ethnicity, and their interactions, adjusting for MCAT score and clustering standard errors at the school level. RESULTS:Among 1,350 students, 448 (33.2%) had a registered disability. The mean Step 2 CK score was 244.3 (SD, 15.1). Students with disabilities scored lower than nondisabled peers (mean 239.6 vs 246.7; adjusted β, -7.02; 95% CI, -8.76 to -5.28). Students with ADHD, learning, or psychological disabilities scored 9-11 points lower than nondisabled peers (P < .001). URiM students scored lower than White students overall (adjusted β, -8.50; 95% CI, -10.74 to -6.25). Intersectional analysis demonstrated that disparities were largest among URiM and Asian students with disabilities. CONCLUSIONS:Medical students with disabilities experience significant disparities in Step 2 CK performance, particularly those with cognitive-based disabilities and intersecting marginalized identities. As Step 2 CK plays a larger role in residency selection, addressing structural barriers in assessment and accommodation processes is critical to advancing equity.

OBJECTIVE:To examine the early experiences influencing research career intentions (RCI) among MD students from racial and ethnic backgrounds underrepresented in medicine (URiM). METHODS:We conducted semi-structured, in-depth interviews with 31 first-year URiM medical students from MD-granting programs across the US to examine student-reported experiences influencing RCI. RESULTS:Participants were first-year medical students (N = 31; mean age 24.8 ± 2.6 years; 64.5% female) identifying as Black (38.7%), Hispanic (32.3%), or Multiracial (29%). Four themes were identified: (1) structured premedical research exposure was described as pivotal to developing early research engagement and interest in research careers; (2) research orientations reflected a commitment to using research as a vehicle for social justice and community impact; (3) high-quality research mentorship was characterized by authentic relational investment, skill development, and the distinct value of racial and ethnic identity-concordant role models; and (4) the research arms race for residency placement was described as amplifying systemic inequities that constrained students' research engagement. Across themes, students described tensions between academic research culture and their personal values, including a desire to advance equity and contribute meaningfully to science. For some, this misalignment made research feel less purposeful or personally aligned. CONCLUSIONS:Medical training programs seeking to support URiM students' RCI should invest in structured premedical research programs and expand access to research mentorship that is both relationally invested and identity concordant. Efforts to cultivate sustained engagement should address publication pressures tied to residency competitiveness, which amplify structural barriers and misalign with students' motivations for pursuing research. Broadening definitions of scholarly contribution and fostering research environments that affirm students' values may be critical to building a robust physician-scientist workforce.

BACKGROUND:While EM departments have designated new leadership roles to focus on diversity, equity, and inclusion (DEI) in recent years, the experiences of DEI leaders have not been thoroughly investigated. The purpose of this study was to describe the factors that impact the effectiveness of DEI leaders within EM. METHODS:We conducted a national qualitative study of DEI leaders in EM. Participants participated in a 60-min semi-structured interview. An interview guide was pilot-tested and iteratively refined. The interview audio was recorded and professionally transcribed. Two team members developed a codebook, independently coded transcripts, and generated categories using content analysis. We analyzed the interview transcripts using inductive and deductive content analysis. Inductive analysis allowed us to identify emerging categories, while deductive analysis allowed us to overlay Camara Jones' Allegory of the Levels of Racism to our data. RESULTS:We completed 24 interviews, representing 21 unique institutions in 14 states. In our adapted allegory, the DEI leader is represented centrally within the ecosystem. The effectiveness of the DEI leader is influenced by institutionally mediated, personally mediated, and internally mediated factors. Institutionally mediated factors included the macroenvironment, administrative positioning, and promotion pathways. Personally mediated factors included communication skills, ongoing leadership development, change management prowess, and seeking colleagues' support. Internally mediated factors included personal commitment to DEI work, as well as feelings of workplace inclusion, imposter syndrome, and tokenism. CONCLUSIONS:This qualitative analysis of EM DEI leaders highlights how factors at various levels influence their experience. Jones's allegory helps conceptualize how a DEI leader functions in a dynamic, continually evolving environment that is sometimes beyond the leader's control. Our research identifies opportunities at the personal, departmental, and institutional levels, such as maintaining a personal commitment to the work, supporting leadership development, and improving administrative positioning that can assist DEI leaders' effectiveness.

OBJECTIVES/OBJECTIVE:Fentanyl test strips (FTS) have the potential to moderate drug use behavior amidst an unregulated drug supply, yet are underutilized in medical settings. We aimed to describe emergency department (ED) FTS distribution across a large NYC health system and examine characteristics associated with clinicians' ordering FTS compared with the current standard-of-care, take-home naloxone (THN), to identify opportunities to optimize FTS distribution. METHODS:We conducted a retrospective review of THN and FTS provision across a large urban health system in its first year of FTS distribution. We evaluated the demographic and clinical characteristics of visits in which clinicians ordered FTS, compared with THN only. RESULTS:From July 20, 2022 to July 20, 2023, 237 (of 423) clinicians ordered THN for 1279 unique individuals in 1376 eligible visits (436 with FTS, 940 without). In pairwise analysis, FTS receipt was associated with being male, younger, non-White, lacking commercial insurance; substance-related or overdose-related visit chief complaint or diagnosis, attending physician, and patient-directed discharge ( P <0.05 for each). In multivariable regression, higher odds of FTS receipt were associated with male gender (OR=2.4; 95% CI=1.8-3.5), a substance-related chief complaint (OR=2.0; 95% CI=1.2-3.2) or visit diagnosis (OR=5.5; 95% CI=3.8-8.0), and overdose visit diagnosis (OR=1.7; 95% CI=1.1-2.8). Lower odds of FTS receipt were associated with older age (OR=0.98; 95% CI=0.97-0.99), noncommunity hospital sites (OR=0.71; 95% CI=0.60-0.83), and non-attending clinicians (OR=0.83; 95% CI=0.69-0.98). CONCLUSIONS:Integrating FTS into an existing ED THN program was feasible without disrupting clinical workflow. ED encounters where FTS were dispensed differed significantly from THN-only, revealing opportunities to optimize FTS ordering.

BACKGROUND:Despite increased efforts to improve student well-being, burnout remains a substantial problem in medical education, and little is known about whether burnout is associated with attrition among medical students across sociodemographic characteristics. OBJECTIVE:To evaluate association between burnout and attrition from medical school across sociodemographic characteristics. DESIGN/METHODS:Retrospective cross-sectional study. SETTING/METHODS:MD-granting US medical schools. PARTICIPANTS/METHODS:Enrolled medical students who completed the Association of American Medical Colleges (AAMC) Year 2 Questionnaire from 2015-2021. MEASUREMENTS/METHODS:Burnout, assessed using the Oldenburg Burnout Inventory for Medical Students and attrition from medical school. RESULTS:Among 62,838 MD Year 2 students in the study cohort, 1,014 (1.6%) left medical school. Female students were less likely to report disengagement-related burnout (aRR:0.80, 95%CI: 0.77-0.83). Compared to White students, Asian (aRR:1.22, 95%CI:1.15-1.28), Black (aRR:1.12, 95%CI:1.05-1.21), and LGB students had a significantly higher risk of disengagement (aRR: 1.33, 95%CI: 1.27-1.40). Similar differences were found for exhaustion-related burnout, with the exception that female students were more likely than male students to be at high risk for exhaustion (aRR:1.37, 95%CI:1.32-1.42). Exhaustion and disengagement were significantly associated with attrition. Compared to the lowest quartile of reported burnout, students reporting exhaustion in the highest quartile were 2-times more likely to leave medical school and students with disengagement were 3-times more likely. Non-White and White female LGB, and non-White male LGB students reporting exhaustion and disengagement in the highest quartile were most likely to leave medical school. LIMITATIONS/CONCLUSIONS:The AAMC Year 2 Questionnaire historically has a response rate of 45-55%, which limits generalizability. CONCLUSIONS:High levels of burnout is associated with twice the risk of attrition for all students. Female, non-White, and LGB students with high risk of burnout were significantly more likely to leave medical school. These findings highlight a need to improve well-being and retention for students at high risk for attrition, including female, non-White, LGB students with high risk for burnout.

BACKGROUND:With increasing efforts to cultivate and foster a diverse physician workforce to improve the delivery of culturally responsive care, the accurate representation of Asian medical students continues to be obscured by aggregation of over 40 ethnic groups that are categorized as Asian race. OBJECTIVE:To describe representation of Asian ethnic groups among applicants and matriculants to US allopathic medical schools. DESIGN AND PARTICIPANTS: Cross-sectional study of applicant and matriculant data from 2020 to 2023, provided by the Association of American Medical Colleges, on self-reported Asian ethnic group and sex of medical school applicants and matriculants, compared with the American Community Survey population estimates of the typical medical school-aged population. MAIN MEASURES/METHODS:For each academic year, Asian ethnic group, and sex, the representation quotient (RQ), defined as the proportion of an ethnic group in the total population of medical school applicants or matriculants relative to the corresponding estimated proportion of that ethnic group in the US population, was calculated. We compared differences in applicant and matriculant RQs using t-tests for those with an RQ less than one. KEY RESULTS/RESULTS:Cambodian, Filipino, Indonesian, and Laotian applicants and matriculants were underrepresented in medicine with an RQ less than one. The RQ of Filipino females was lower than Filipino males among applicants and matriculants (p = 0.04 and 0.04, respectively). The RQ of Laotian and Filipino matriculants were lower than their respective applicant representation (p = 0.01 and 0.02, respectively). CONCLUSIONS:With disaggregated race and ethnicity data, we found significant variation in representation of Asian ethnic groups among medical school applicants and matriculants relative to the US population. Aggregating Asians into a single racial group conceals a more nuanced picture of representation in medicine, hindering efforts for a diverse workforce and improved patient care.

IMPORTANCE/UNASSIGNED:Membership in both the Alpha Omega Alpha (AOA) and Gold Humanism Honor Society (GHHS) is positively associated with career advancement. Prior studies have shown that Asian American medical students are less likely to be selected for these societies, but it is unknown whether representation among specific Asian American subgroups differ. OBJECTIVE/UNASSIGNED:To examine the association between AOA and GHHS membership and self-reported ethnicity among Asian American students at US doctor of medicine (MD)-granting medical schools. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This retrospective cross-sectional study analyzed deidentified data from the Association of American Medical Colleges, focusing on allopathic medical students graduating between 2018 and 2021. Data analysis was conducted from July 10, 2024, to January 26, 2026. EXPOSURE/UNASSIGNED:Self-reported race and Asian ethnicity. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was AOA and GHHS membership at graduation. Multivariable logistic regression was performed, adjusting for Medical College Admission Test score, childhood income, sex, and sexual orientation, and clustered by medical school. RESULTS/UNASSIGNED:Among 55 632 graduating medical students, 28 127 (50.6%) self-identified as female and 10 867 (19.5%) as Asian American. AOA membership was reported by 10 126 students (18.2%), and GHHS membership was reported by 8623 students (15.5%). Bangladeshi (odds ratio [OR], 0.35; 95% CI, 0.20-0.61), Chinese (OR, 0.51; 95% CI, 0.44-0.58), Filipino (adjusted OR, 0.44; 95% CI, 0.29-0.65), Indian (OR, 0.56; 95% CI, 0.50-0.63), Japanese (OR, 0.48; 95% CI, 0.28-0.81), Korean (OR, 0.41; 95% CI, 0.33-0.51), Pakistani (OR, 0.46; 95% CI, 0.34-0.63), Taiwanese (OR, 0.38; 95% CI, 0.28-0.51), and Vietnamese (OR, 0.56; 95% CI, 0.45-0.71) students were less likely to be AOA members than White students. Chinese (OR, 0.67; 95% CI, 0.58-0.78), Korean (OR, 0.55; 95% CI, 0.43-0.69), and Taiwanese (OR, 0.67; 95% CI, 0.49-0.91) students were less likely to be GHHS members compared with White students. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cross-sectional study of graduating medical students found widespread underrepresentation of most Asian American subgroups in AOA membership and for Chinese, Korean, and Taiwanese medical students in GHHS membership. This underscores the importance of disaggregating Asian American individuals in medicine to unmask disparities and provide opportunities to promote greater inclusion in medicine.