Faculty Bibliography

BACKGROUND:Achieving racial equity in sepsis care is a complex challenge that requires organizational readiness across multiple domains, such as culture and capacity. OBJECTIVES/OBJECTIVE:This study provides a validated tool to empirically measure health system readiness to address structural racism in sepsis care, essential for improving health equity and patient outcomes. METHODS:This study employed a mixed methods approach involving three key steps: adaptation, cognitive interviews, and psychometric analysis. The novel survey was first adapted based on a literature review and expert input. Cognitive interviews were conducted with healthcare professionals to refine the survey items. Finally, reliability testing was performed for psychometric analysis in measuring health system readiness to address structural racism in sepsis care. The survey was developed in the context of Champions Advancing Racial Equity in Sepsis (CARES), a coalition-based leadership intervention to equip health systems and their surrounding communities to identify and address racial inequities in sepsis care and outcomes. Senior and mid-level and front-line champions from across disciplines and departments that influence sepsis care (N = 30) participated in the survey. RESULTS:The survey consisted of five domains: learning and problem solving (10 items, Cronbach's α = 0.815), stress/pressure in the system (4 items, Cronbach's α = .779), psychological safety (7 items, Cronbach's α = .515), senior leadership support (4 items, Cronbach's α = .744), and strategic planning process (5 items, Cronbach's α = .918). Overall, the entire scale (30 items) was found to have excellent reliability (Cronbach's α = .908). CONCLUSIONS:This study adapted and validated a novel survey to measure health system readiness to address structural racism in sepsis care, providing a reliable tool for identifying areas for improvement and guiding targeted interventions to enhance health equity.

BACKGROUND:Endotracheal intubation in the emergency department (ED) is a critical and time-sensitive procedure requiring both technical skills and cognitive-based reasoning. Evidence on supervised resident-attending dyads with differing years of seniority on decision making during clinical encounters with endotracheal intubations is nascent. OBJECTIVE:To investigate the intersection of postgraduate years in clinical practice between resident and attending supervisor dyads and its associations for clinician choice of laryngoscopy technique and paralytic agent during ED intubations. METHODS:We conducted a retrospective analysis of intubations performed at a multi-site, urban, academic emergency medicine training program, analyzing institutional airway registry data from 2013 to 2023. Using a standardized predictor that accounted for similarity in years of clinical experience within a dyad between a resident and their supervising attending, we performed adjusted mixed-effects logistic regression examining the association of this dyad on two primary outcomes in endotracheal intubation decision making. Our primary outcome measures were the selection of a laryngoscopy technique (either DL or VL), and of a paralytic agent (either short-acting or long-acting) analyzed as categorical variables with a linear mixed effects model, using a binomial response distribution. RESULTS:We examined 2969 intubations for choice of laryngoscopy technique (n = 1117, 37.6 %) and paralytic agent (n = 967, 32.6 %). Higher adjusted odds (aOR) were associated with resident choice of DL over VL when years of experience between residents and supervising attendings were more concordant (aOR 3.05, 95 % CI: 1.1-8.2). Choice of paralytic agent was not associated with differing years of experience. CONCLUSION/CONCLUSIONS:Concordant years of experience between residents and their attendings were associated with technical skill-based laryngoscopy technique choice but not for cognitive-based reasoning in paralytic agent choice among ED intubations, suggesting supervising attending's years in clinical practice may influence decision making during time-sensitive procedures.

PURPOSE/OBJECTIVE:Racial and ethnic underrepresentation in medicine (URiM) threatens the capacity of the cancer physician workforce to provide accessible, culturally competent care. We projected racial and ethnic diversity of the workforce through 2060 under three scenarios. METHODS:We assessed workforce composition using data from the American Medical Association (physician specialty and age) and Association of American Medical Colleges (race/ethnicity) in 2020. We defined URiM as American Indian/Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; or Native-Hawaiian/Pacific-Islander. We used stock-and-flow models based on 2020 data to project the racial and ethnic distribution of the workforce by decade from 2030 to 2060 across three scenarios: baseline (URiM distribution remains at 2020 levels); trajectory (growth of URiM% physicians continues at current rates); and doubling (URiM growth is twice the rate of non-URiM growth). We calculated representation ratios (RR) by dividing workforce share by population share for each race group. Finally, we estimated growth in URiM physicians required for the workforce to reach parity with the 2060 US population. RESULTS:In 2020, there were 66,450 cancer physicians (11.3% URiM overall, radiation oncology 8.2%, medical oncology 9.9%, surgical oncology 10.2%, palliative care 11.8%, general surgery 13.6%) compared with 31% of the US population. Under baseline conditions, 12.5% of the workforce would be URiM in 2060, compared with 43.2% of the US population (RR, 0.29). Continuing 2010-2020 trends would raise 2060 URiM representation to 16.5% (RR, 0.38). Doubling URiM growth relative to non-URiM would raise 2060 URiM representation to 19.1% (RR, 0.44). Achieving parity would require increasing URiM physicians entering the workforce by 9.5% per decade. CONCLUSION/CONCLUSIONS:Across various scenarios of physician recruitment, URiM representation in the cancer physician workforce will remain below half the US population share by 2060.

BACKGROUND:Fall injury is a sentinel event for mortality among older adults, and activity intensity may play a role in mitigating this outcome. This study assessed the relationship between activity intensity and all-cause mortality following fall injury among community-dwelling U.S. older adults. METHODS:For this retrospective cohort study, we pooled 12 years of data from the National Health Interview Survey and identified older adults (aged 65 years and older) who sustained fall injuries (N = 2454). The outcome variable was time to death following a fall injury. We defined activity intensity as a binary variable, none-to-low and normal-to-high, using the American Heart Association's weekly 500 Metabolic Equivalent of Task (MET) as a cutoff. We controlled for sociodemographic, healthcare access, and health characteristics; performed survey-weighted Cox proportional hazard regression analysis; and reported the adjusted mortality risks (plus 95% confidence interval (CI)). RESULTS:The survey comprised 2454 older adults with fall injuries, representing 863,845 US older adults. The population was predominantly female (68%), non-Hispanic White (85%), and divorced/separated (54%). During the follow-up period, 45% of the study population died. Approximately 81% of the study population had low activity levels. However, between 2006 and 2017, the proportion of the study population with low physical activity decreased from 90% to 67%. After adjusting for sociodemographic, healthcare access, and health characteristics, none-to-low activity intensity was associated with 50% increased mortality risk (aHR: 1.50; 95% CI: 1.20-1.87). CONCLUSIONS:Promoting higher physical activity levels may significantly reduce the all-cause mortality risk following fall injury among older adults.

IMPORTANCE/UNASSIGNED:Previous research has documented the prevalence of discrimination based on race, ethnicity, sex, and sexual orientation among medical students; however, discrimination experienced by medical students with disabilities, and the impact of intersecting identities on these experiences, remains underexplored. OBJECTIVE/UNASSIGNED:To examine the association of general, gender-based, and race-based discrimination with disability status, sex, race, and ethnicity during medical school. DESIGN, SETTINGS, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study surveyed graduating medical students in US accredited MD-granting medical schools from 2020 to 2022. Analyses were conducted from October to November 2024. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Modified Poisson regression was used to estimate the relative risk of disability status, sex, race, and ethnicity with self-reported experiences of general, gender-based, and race-based discrimination and the intersection of disability status, sex, race, and ethnicity. RESULTS/UNASSIGNED:Among 45 705 graduating medical students, 3863 (8.5%) reported having a disability; 24 163 (52.9%) identified as female; and 10 100 (22.1%) identified as Asian, 2661 (5.8%) as Black, 4524 (9.9%) as Hispanic, 25 154 (55.0%) as White, and 3266 (7.1%) as other race or ethnicity. Medical students with disability (MSWD) were more likely than their peers without disability to report general discrimination (relative risk [RR], 1.57; 95% CI, 1.50-1.65), gender-based discrimination (RR, 1.64; 95% CI, 1.57-1.72), race-based discrimination (RR, 1.55; 95% CI, 1.44-1.67), and multiple types of discrimination (RR, 1.82; 95% CI, 1.71-1.91). Asian, Black, and Hispanic female MSWD were more likely to report general and race-based discrimination than their White male peers without disability, with the prevalence of general, gender-based, and race-based discrimination among female Asian, Black, and Hispanic MSWD being greater than 25%. Compared with White male students without disability, Asian and Black female MSWD reported the highest risk of general discrimination (Asian: RR, 2.40; 95% CI, 2.09-2.77; Black: RR, 2.58; 95% CI, 2.17-3.06). White and Asian female MSWD reported the highest risk of gender-based discrimination (White: RR, 4.65; 95% CI, 4.30-5.04; Asian: RR, 4.41; 95% CI, 3.85-5.05). Asian and Black female MSWD reported the highest risk of race-based discrimination (Asian: RR, 8.53; 95% CI, 7.26-10.01; Black: RR, 12.48; 95% CI, 10.76-14.47). Finally, Asian and Black female MSWD reported the highest risk of multiple types of discrimination (Asian: RR, 6.50; 95% CI, 5.63-7.52; Black: RR, 7.21; 95% CI, 6.10-8.52). CONCLUSIONS/UNASSIGNED:In this cross-sectional study of US medical students, Asian, Black, and Hispanic female MSWD were more likely to report general and race-based discrimination, whereas White and Asian female MSWD were more likely to report gender-based discrimination during medical school. These findings highlight the need to address intersecting forms of discrimination for medical students with disabilities.

OBJECTIVES/OBJECTIVE:The 2024 Society for Academic Emergency Medicine Consensus Conference focused on developing a pathway to build and support a diverse and sustainable emergency medicine (EM) clinician-scientist workforce. The underlying premise is that the specialty of EM needs a robust clinician-scientist workforce to fulfill its research mission of creating new knowledge to improve patient care and outcomes. METHODS:Preconference workgroups assessed existing pathways to develop and support EM clinician-scientists and generated unranked lists of strategies to holistically and comprehensively grow the clinician-scientist workforce. These strategies were refined and prioritized during a one-day, in-person conference, which was followed by a virtual conference to reach consensus on metrics, goals, and timelines for implementation. RESULTS:Overarching strategies included fostering a departmental culture that values research, addressing barriers to recruiting and retaining a diverse research work force, and enhancing the national reputation of EM research. At the undergraduate and medical school stage, creating a portfolio of medium- and long-term research training opportunities with EM faculty mentors was the highest priority. At the resident and fellow stage, top priorities were dedicated research training built into EM residencies and clinical fellowships. Early-career faculty strategies prioritized departmental support for federally funded K awards. Mid-career faculty strategies prioritized securing federal support for research mentoring, leading institutional training grants, and building research teams that include PhD scientists. At all stages, we addressed recruitment and retention of trainees and faculty from disadvantaged and underserved groups. CONCLUSIONS:These prioritized strategies with respective metrics, goals, timelines, and responsible parties provide a roadmap for EM to build a broadly inclusive and sustainable clinician-scientist workforce, capable of creating the new knowledge needed to advance emergency medical care. Successful implementation will require substantial commitment and investment from national EM organizations and academic department chairs. The result will be improved care and outcomes for the patients and communities we serve.

IMPORTANCE/UNASSIGNED:The 2023 Supreme Court of the United States (SCOTUS) Students for Fair Admissions, Inc. v President and Fellows of Harvard College ruling to restrict race-based affirmative action is a landmark decision with potentially far-reaching consequences. OBJECTIVE/UNASSIGNED:To examine application, acceptance, and matriculation rates into doctor of medicine (MD)-granting programs before and after the 2023 SCOTUS decision. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This retrospective cross-sectional study used deidentified data from the Association of American Medical Colleges on applicants and matriculants to US MD-granting medical schools 5 years before (2019-2023) and 1 year after (2024) the SCOTUS ruling. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Application, acceptance, and matriculation into MD-granting programs. RESULTS/UNASSIGNED:The study sample included 291 764 applicants to MD programs between 2019 and 2024 (162 211 identifying as female [55.59%]; 4576 American Indian, Alaska Native, Native Hawaiian, or Pacific Islander [1.57%], 84 122 Asian [28.83%], 34 256 Black [11.74%], 35 707 Hispanic [12.24%], and 154 621 White [53.00%]). Compared with mean acceptance rates in 2019 to 2023, acceptance rates in 2024 were higher for White (40.37% vs 47.47%; difference, 7.10 percentage points [95% CI, 6.21 to 7.98 percentage points]; P < .001) and Asian (38.26% vs 45.19%; difference, 6.93 percentage points [95% CI, 5.78 to 8.07 percentage points]; P < .001) applicants and lower for Black applicants (36.06% vs 33.08%; difference, -2.98 percentage points [95% CI, -4.74 to -1.21 percentage points]; P < .001) and underrepresented in medicine (URiM) applicants overall (39.68% vs 38.33%; difference, -1.35 percentage points [95% CI, -2.60 to -0.09 percentage points]; P = .02). No racial or ethnic difference in acceptance rates were observed in 2019 to 2023, but in 2024, URiM applicants had significantly lower acceptance rates than White (difference, -9.14 percentage points; P < .001) and Asian (difference, -6.86 percentage points; P < .001) applicants. Comparing the mean of 18 304 matriculants in 2019 to 2023 with 19 018 matriculants in 2024, White student representation decreased from 10 132 matriculants (55.35%) to 10 158 matriculants (53.41%) for a decrease of 1.94 percentage points (95% CI, -3.31 to -0.56 percentage points; P = .009), Asian student representation increased from 5102 matriculants (27.87%) to 6288 matriculants (33.06%) for an increase of by 5.19 percentages points (95% CI, 3.49 to 6.88 percentage points; P < .001), and URiM student representation decreased from 4466 matriculants (24.39%) to 3963 matriculants (20.83%) for a decrease of 3.56 percentage points (95% CI, -5.34 to -1.77 percentage points; P < .001), equating to 503 fewer URiM matriculants in 2024. Post-SCOTUS decision declines in URiM representation were concentrated in schools located in states without prior state-level affirmative action bans (mean [SD] change, -6.14 [8.93] percentage points vs 0.10 [8.11] percentage points; P < .001). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, URiM student matriculation into US medical schools declined after the 2023 SCOTUS ruling, with an emergent disparity in acceptance rates of URiM applicants relative to Asian and White students. The decline in URiM student matriculation was concentrated in states without a preexisting state-level affirmative action ban, suggesting that there may be an association between the SCOTUS ruling and demographic changes in matriculation.

BACKGROUND:Recruitment of a more diverse obstetrics and gynecology workforce may help improve patient outcomes in the US, particularly among women of color. Visiting rotations play a role in competing for a position in an obstetrics and gynecology residency, however, not all students may be able to complete these expensive experiences. Our objective was to evaluate socioeconomic and other demographic differences among US obstetrics and gynecology-bound students who participate in visiting rotations versus those who do not. METHODS:We obtained de-identified data from the Association of American Medical Colleges for students graduating in US allopathic medical schools 2019 or 2020. We analyzed self-reported receipt of state and/or federal assistance to obtain postsecondary education, medical education debt, sex, and race and ethnicity data using chi-square and ANOVA analyses and logistic regression. RESULTS:Of 33,287 US graduating medical students, 1978 (5.9%) indicated "Obstetrics and Gynecology" as their intended practice and included socio-demographic data; 1110 (56.1%) of these completed at least one visiting rotation. In multivariable analysis controlling for medical education debt, race and ethnicity, and sex, students with moderate debt were less likely to complete any visiting rotation (aOR 0.68, 95% CI: 0.52, 0.89) and students with any debt were less likely to complete two or more visiting rotations than those without debt. However, Black students were significantly more likely to complete two or more rotations than white students when adjusted for debt and sex (aOR 1.48, 95% CI: 1.02, 2.11). CONCLUSIONS:Among US obstetrics and gynecology-bound medical students, moderate medical education debt was associated with lower odds of completing visiting rotations when adjusted for race and ethnicity and sex. Black students were more likely to complete two or more visiting rotations compared to their white counterparts when adjusted for levels of debt, perhaps to improve the likelihood of a successful match that is lower than that of their white colleagues despite the risk of worsening their debt. Providing more financial support or deemphasizing the visiting rotation as part of the application could help recruit a workforce that better reflects the diversity of the general population.