Faculty Bibliography

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.

IMPORTANCE/UNASSIGNED:Limited research exists on sex, racial, and ethnic disparities in required graduate medical education (GME) resident competency ratings across specialties during sensitive periods when career decision-making occurs. Rating disparities using an antideficit-based approach measured by exceptionally high ratings are underexplored in GME. OBJECTIVE/UNASSIGNED:To assess the association of exceptionally high ratings in the Accreditation Council for Graduate Medical Education (ACGME) Milestones during time-sensitive training periods across specialties with differences among residents' characteristics, including sex, race, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional analysis was conducted between March 15 and December 31, 2025, using 2018 to 2021 Association of American Medical Colleges and ACGME data. Postgraduate year (PGY) 2 residents training at US ACGME-accredited emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery residency programs between 2018 and 2021 who self-reported sex, race, or ethnicity were studied. EXPOSURE/UNASSIGNED:Required Milestones ratings at the end of PGY-2 training associated with resident sex and race or ethnicity (underrepresented in medicine [URiM] and Asian), while controlling for preresidency Step 2 Clinical Knowledge examination scores. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Proportion and adjusted odds ratios (AORs) for exceptionally high resident-level ratings (80th percentile level) across competencies in interpersonal and communication skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and systems-based practice. RESULTS/UNASSIGNED:Among 19 492 PGY-2 residents across 1754 programs, 10 384 (53.3%) were female, 28 (0.14%) American Indian or Alaskan Native, 4327 (22.2%) Asian, 1106 (5.7%) Black, 1008 (5.2%) Hispanic or Latinx, 3 (0.02%) Native Hawaiian or Pacific Islander, 12 269 (62.9%) White, 751 (3.9%) reporting 2 or more races, and 3423 (17.6%) classified as URiM. Exceptional rating differences were identified by sex, race, and ethnicity. Across all specialties, female residents had greater odds for 80th percentile ratings (AOR, 1.12; 95% CI, 1.05-1.21; P < .001); whereas when compared with White residents, URiM residents (AOR, 0.68; 95% CI, 0.62-0.76; P < .001) and Asian residents (AOR, 0.67; 95% CI, 0.60-0.74; P < .001) were less likely to have 80th percentile ratings than White residents. Within specialties, URiM residents in emergency medicine, family medicine, internal medicine, obstetrics and gynecology, and surgery were less likely to have 80th percentile ratings, whereas Asian residents in family medicine, internal medicine, pediatrics, and surgery were also less likely than White residents. CONCLUSION AND RELEVANCE/UNASSIGNED:In this cross-sectional national study of residents, exceptionally higher ratings were associated with differing resident characteristics during crucial career planning phases. These results suggest the need for more studies to explore factors of resident success during GME training.

INTRODUCTION/BACKGROUND:Physicians engaged in public health play a critical role in advancing population health, yet this workforce remains small. This study examines sociodemographic and educational factors associated with early interest in public health careers among first-year U.S. medical students. METHODS:This study analyzed baseline data from 1,136 participants in the Longitudinal Evaluation of Research Career Intentions Among U.S. Medical Students (LEAP-URiM) study. The data utilized was collected from January 2024 through May 2024. Participants were classified according to their intention to engage in public health work after completing medical training. Age, sex assigned at birth, sexual orientation, birth country, prior public health degree, childhood socioeconomic disadvantage, and Underrepresented in Medicine (URiM) status were evaluated for associations with public health career intentions using logistic regression. All statistical analyses were done in November 2024. RESULTS:In this sample, 55.7% of first-year medical students reported an interest in public health post medical training. In the adjusted model, factors associated with higher odds of intending to pursue a career in public health included being female (aOR: 2.14, 95% CI: 1.63-2.78), non-heterosexual (aOR: 1.44, 95% CI: 1.04-1.99), non-US born (aOR: 1.45, 95% CI: 1.04-2.03), being URiM (aOR:1.38, 95% CI: 1.03-1.86), possessing a public health degree (aOR: 4.04, 95% CI: 1.54-6.08), and disadvantaged childhood (aOR: 2.09, 95% CI: 1.28-3.41). CONCLUSIONS:Interest in public health among medical students varies by sociodemographic and educational characteristics. These findings may inform future research and workforce development efforts focused on the public health physician pipeline.

BACKGROUND:This cross-sectional study aimed to develop and validate measures of perceptions, attitudes, and practices to support physical activity among older adults. METHOD/METHODS:We enrolled online 310 community-dwelling U.S. older adults and 11 content experts. Using the Knowledge, Attitudes, and Practices framework, we developed 14, seven, and nine items for the Perceived Physical Activity Benefits Scale (PBAS), Attitudes toward Physical Activity Scale (APAS), and Physical Activity Practice Scale (PAPS), respectively. We generated derivation and replication samples using a 30:70 simple random split. Content validity and item analyses were performed on the full sample, followed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for derivation and replication samples, respectively. RESULTS:Item-level content validity indices for the PBAS, APAS, and PAPS were 0.96, 0.94, and 0.95, respectively. Also, the internal consistencies for the PBAS, APAS, and PAPS were 0.92, 0.77, and 0.91, respectively. Our EFA identified two subscale constructs for each measure, with good subscale reliability. CFA fit index ranges for the PBAS, APAS, and PAPS were 0.90-0.94, 0.97-0.99, and 0.95-0.97. CONCLUSIONS:The PBAS, APAS, and PAPS are reliable and valid instruments for assessing perceptions, attitudes, and practices related to physical activity among older adults.

BACKGROUND:Motivational text messages can encourage increased physical activity. This study aimed to validate motivational text messages among older adults and care partners and to assess differences in perceived motivational value between the two groups. METHODS:We designed nine motivational text messages to capture nine distinct physical activity scenarios. For this cross-sectional observational study, we enrolled 14 content experts, 310 older adults, and 305 care partners. Content experts assessed the relevance, while the older adults and care partners assessed the perceived motivational value of each text message on a 5-point Likert scale. We computed the item content validity index and assessed differences in perceived motivational value among older adults and care partners using quantile regression while adjusting for sociodemographic and health characteristics. RESULTS:The item content validity index ranged from 0.86 to 1.00. The median (interquartile range) perceived motivational value for each text message was 4.0 (3.0-5.0), and there were no statistically significant differences in reported motivational values between older adults and care partners. CONCLUSION/CONCLUSIONS:We present nine content-validated text messages with high motivational value for older adults and care partners that can be integrated into technology-based intervention studies and may improve physical activity behavior in both groups.

IMPORTANCE/UNASSIGNED:At a time when diversity in higher education is increasingly perceived as beneficial only to minority students and disadvantaging to majority-group students, it is crucial to investigate its benefits broadly. OBJECTIVE/UNASSIGNED:To assess whether meaningful interactional diversity (ie, cross-cultural engagement that influences knowledge or opinions) is associated with key educational outcomes among White medical students. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study included self-identified White-only medical students who matriculated to a US allopathic medical school between 2013 and 2022, graduated between 2015 and 2024, and responded to the Association of American Medical Colleges Graduation Questionnaire (GQ). GQ responses were anonymous. Data were analyzed from September 2024 to April 2025. EXPOSURE/UNASSIGNED:Meaningful interactional diversity, defined by agreement on a 5-point Likert scale with the GQ item, "My knowledge or opinion was influenced or changed by becoming more aware of the perspectives of individuals from different backgrounds." MAIN OUTCOMES AND MEASURES/UNASSIGNED:Six self-reported binary outcomes derived from the GQ were assessed: personal and professional development fostered by medical schools, ability to care for and work with people from different backgrounds, and intention to work in an underserved area and with an underserved population regardless of practice location. RESULTS/UNASSIGNED:Among 80 542 students (38 589 [47.91%] female) from 155 medical schools, 495 (0.61%) strongly disagreed, 1416 (1.76%) disagreed, 7387 (9.17%) were neutral, 35 155 (43.65%) agreed, and 36 089 (44.81%) strongly agreed with meaningful interactional diversity. Across increasing agreement with meaningful interactional diversity, higher likelihoods of personal and professional development and care and teamwork competence were observed, whereas associations with service intentions were confined to strong agreement. Compared with strong disagreement, strong agreement was associated with greater personal (adjusted relative risk [aRR], 2.37; 95% CI, 2.05-2.74) and professional (aRR, 1.59; 95% CI, 1.42-1.69) development, competence to care for (aRR, 1.23; 95% CI, 1.17-1.29) and work with (aRR, 10.69; 95% CI, 7.84-14.57) people from different backgrounds, and plans to work in underserved areas (aRR, 1.31; 95% CI, 1.08-1.58) or with underserved populations regardless of practice location (aRR, 1.59; 95% CI, 1.30-1.93). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cross-sectional study of White medical students, meaningful interactional diversity was associated with graded improvements in core developmental outcomes and threshold-level associations with service intentions.