Faculty Bibliography

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.

BACKGROUND:There is a lack of diversity in the Internal Medicine (IM) workforce with respect to race, ethnicity, sex, and socioeconomic background. Evaluating sociodemographic predictors and student interest in IM residency may provide insights for support at the medical school level to promote diverse interest in IM. OBJECTIVE:To examine associations between student ethnoracial identity, sex, and socioeconomic background with IM interest from matriculation to graduation. DESIGN/METHODS:Retrospective cohort study. PARTICIPANTS/METHODS:US MD matriculants from 2014-2015 and 2015-2016 cohorts. MAIN MEASURES/METHODS:A sustained interest was defined as IM interest at matriculation and subsequent IM residency placement. A cultivated interest was defined as initial non-IM interest and placement into IM residency. Poisson regressions estimated associations between ethnoracial identity, sex, and family income with sustained or cultivated interest in IM, adjusting for IM clerkship satisfaction, USMLE Step 1 and Step 2 score. KEY RESULTS/RESULTS:Among 18,765 matriculants, 51.7% identified as female, 61.5% as White, and 24.3% as low-income. IM clerkship satisfaction was associated with IM residency placement (p < 0.001). Among students initially interested in IM, females (aRR 0.87, 95% CI [0.80-0.94]) were less likely to sustain interest. Among initially uninterested students, Asian (aRR 1.65, 95% CI [1.54-1.76]), Hispanic (aRR 1.31, 95% CI [1.16-1.48]), and Black (aRR 1.22, 95% CI [1.07-1.39]) students were more likely to report cultivated interest compared to White students, while females were less likely compared to male students (aRR 0.77, 95% CI [0.72-0.82]). CONCLUSION/CONCLUSIONS:Disparities in IM workforce diversity may originate in medical school, where female students were less likely to sustain IM interest, while Asian, Black, and Hispanic students were more likely to develop interest. Such results necessitate targeted support by medical schools and graduate medical education programs.