Dataset Information

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010-2020.

ABSTRACT:

Background

Quality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM). Research on increasing diversity within the academic medicine student body or faculty notes the important role of leadership. Yet, there is a scarcity in research into diversity in leadership.

Objective

The purpose of this study is to go beyond aggregate numbers and answer the question: What is the level of parity representation, by gender and race, at department chair positions in academic IM departments?

Design

A cross-sectional analysis of race/ethnicity and gender in IM medical school departments from 2010 to 2020 was conducted using data from the American Association of Medical College's (AAMC) Faculty Roster. The proportion of IM department chairs to IM faculty by race/ethnicity for each year (2010-2020) was used to calculate the Leadership Parity Index (LPI) in this study. LPI by gender and by gender and race/ethnicity were also calculated for each year.

Results

In aggregate numbers, Black or African American and Hispanic, Latino, or of Spanish Origin faculty remain under-represented in academic IM each making up, on average, approximately 4% of the total IM faculty. The LPI calculations revealed that faculty who identified as White were consistently over-represented as department chairs while Asian faculty were consistently under-represented in leadership and ranked lowest in leadership parity among the ethnic groups studied. The leadership parity index also showed that women faculty across all races were under-represented.

Conclusion

Women and Asian faculty encounter a ceiling effect that may be at play in IM departments. While significant progress still needs to be made in the representation of under-represented minorities, the findings of this study show that aggregate data does not provide a true picture of equity and parity in Internal Medicine faculties.

SUBMITTER: Samuel A

PROVIDER: S-EPMC10039186 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010-2020.

Samuel Anita A Cervero Ronald M RM Durning Steven J SJ

Journal of general internal medicine 20221028 4

<h4>Background</h4>Quality medical education, reduction in health disparities, and healthcare research that includes all members of society are enhanced by diversity in departments of internal medicine (IM). Research on increasing diversity within the academic medicine student body or faculty notes the important role of leadership. Yet, there is a scarcity in research into diversity in leadership.<h4>Objective</h4>The purpose of this study is to go beyond aggregate numbers and answer the questio ...[more]

PMID: 36307643

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Project description:ImportanceThe number of women entering medicine continues to increase, but women remain underrepresented at all tiers of academic rank and chair leadership in EM. The proportion of female chairs in EM has not exceeded 12% in 2 decades.ObjectiveTo compare how male and female EM chairs experience leadership emergence, with attention to factors associated with support of the emergence of female chairs.Design, setting, and participantsThis qualitative descriptive study was conducted between April 2020 and February 2021 at 36 US academic EM departments. Eligible participants were all current and emeritus female EM academic department chairs (with a possible cohort of 20 individuals) and an equal number of randomly selected male chairs.InterventionsSemistructured interviews were conducted via teleconferencing with an 11-item interview guide.Main outcomes and measuresQualitative findings identifying similarities and gender differences in leadership emergence were collected.ResultsAmong 20 female chairs in EM, 19 women (mean [SD] age, 56.2 [7.1] years) participated in the study (95.0% response rate). There were 13 active chairs, and 6 women were within 5 years of chair leadership. Among 77 male chairs in EM identified and randomized, 37 men were invited to participate, among whom 19 individuals (51.4%) agreed to participate; 18 men (mean [SD] age, 52.2 [7.5] years) completed their interviews. Reflecting upon their experiences of leadership emergence, male chairs saw leadership as their destiny, were motivated to be chairs to gain influence, were dismissive of risks associated with chairing a department, and were sponsored by senior male leaders to advance in leadership. Female chairs saw leadership as something they had long prepared for, were motivated to be chairs to make a difference, were cautious of risks associated with chairing a department that could derail their careers, and relied on their own efforts to advance in leadership.Conclusions and relevanceThis study found that experiences of leadership emergence differed by gender. These results suggest that leadership development strategies tailored to women should promote early internalization of leadership identity, tightly link leadership to purpose, cultivate active sponsorship, and encourage women's risk tolerance through leadership validation to support women's development as leaders and demonstrate a commitment to gender equity in EM leadership.

Project description:ImportanceIncreasing underrepresented in medicine (URIM) physicians among historically underserved communities helps reduce health disparities. The concordance of URIM physicians with their communities improves access to care, particularly for American Indian and Alaska Native, Black, and Hispanic or Latinx individuals.ObjectivesTo explore county-level racial and ethnic representation of US internal medicine (IM) residents, examine racial and ethnic concordance between residents and their communities, and assess whether representation varies by presence of academic institutions or underserved settings.Design, setting, and participantsThis retrospective cross-sectional study collected data from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education (ACGME), Area Health Resources Files, and US Department of Education data on ACGME-accredited US IM residency programs and their associated county populations. Self-reported racial and ethnic data from 2018 for 4848 residents in 393 IM programs in 205 counties were used. Data were analyzed between February 15 and September 20, 2024.ExposureCounty-level presence for academic health centers (AHCs), minority-serving institutions (MSIs), health professional shortage areas (HPSAs), and rurality.Main outcomes and measuresMain outcomes were representation quotients (RQs) or the ratio of the proportion of IM residents and their concordant county-level racial and ethnic populations. Quantile linear regression models on median representation were used to identify the association with URIM, Asian, and White residents by US Census division and county-level AHCs, MSIs, HPSAs, and rurality.ResultsAmong 4848 residents, 4 (0.08%) self-identified as American Indian or Alaskan Native, 1709 (35.3%) as Asian, 289 (6.0%) as Black, 211 (4.4%) as Hispanic or Latinx, 2 (0.04%) as Native Hawaiian or Other Pacific Islander, and 2633 (54.3%) as White. A total of 761 (15.7%) were classified as URIM. Among URIM groups, American Indian and Alaska Native (mean [SE] RQ, 0.00 [0.04]), Black (mean [SE] RQ, 0.09 [0.20]), Hispanic and Latinx (mean [SE] RQ, 0.00 [0.04]), and Native Hawaiian and other Pacific Islander (mean [SE] RQ, 0.00 [0.26]) residents were grossly underrepresented compared with their training sites' county-level representation. Fifty-one of 205 counties (24.8%) with IM programs had no URIM residents. Black and Hispanic or Latinx residents had higher representation in counties with more MSIs (mean [SD] RQ, 0.19 [0.24]; P = .04; mean [SD] RQ, 0.15 [0.04]; P < .001, respectively), and Hispanic or Latinx residents were less represented in counties with more AHCs (mean [SD] RQ, 0.00 [0.06]; P < .001). Asian residents had lower RQs in counties with more MSIs (mean [SD] RQ, 6.00 [0.65]; P < .001), and White residents had higher representation in counties with greater presence of AHCs (mean [SD] RQ, 0.77 [0.04]; P = .007).Conclusions and relevanceIn this cross-sectional study, URIM IM residents remained underrepresented compared with their program's county populations. These findings should inform racial and ethnic diversity policies to address the continuing underrepresentation among graduate medical education physicians, which adversely impacts the care of historically underserved communities.

Project description:Importance:The persistence of inequities that disadvantage women physicians remains empirically underexplained. Understanding the cultural factors that are associated with disparities in harassment, discrimination, remuneration, and career trajectory are critical to addressing inequities. Objectives:To explore how physicians perceive the climate for women physicians and compare perceptions and experiences of gender inequity among physicians based on characteristics including gender, faculty status, parental status, and years in practice. Design, Setting, and Participants:This sequential, explanatory, mixed-methods qualitative study used the Culture Conducive to Women's Academic Success (CCWAS; range 45-225, with higher scores indicating better perceived culture toward women), followed by individual semistructured interviews with physicians at the Department of Medicine of the University of Calgary. All 389 physician members of the Department of Medicine, including academic and clinical physicians and those of any gender, were invited to participate in the survey and interview phases. Main Outcomes and Measures:The culture within the department for women physicians was assessed using the CCWAS score. Scores were compared between respondents' gender and years in practice. Interviews with physicians were used to further explore findings from the CCWAS and to understand experiences and perceptions of gender disparities. Results:A total of 169 of 389 physicians completed the survey (response rate, 43.4%; 102 [59.9%] women; 65 [38.9%] men; and 2 [1.2%] who did not disclose gender); 28 participants (7.2%) elected to participate in an interview (22 [78.6%] women; 6 [21.4%] men). Women physicians perceived the culture of the department toward women as significantly worse than men physicians (median [interquartile range] CCWAS score, 137.0 [118.0-155.0] vs 164.5 [154.0-183.4]; P < .001). Physicians with more than 15 years in practice perceived the culture toward women as significantly more favorable than physicians with 15 years or less in practice (median [interquartile range] CCWAS score, 157.0 [138.8-181.3] vs 147.0 [127.5-164.3]; P = .02). Qualitative data demonstrated that experiences of junior women (ie, physicians who graduated medical school after 1996, when an equal number of men and women in medical school was achieved in Canada) and perceptions of senior men (ie, those who graduated before 1996) were most different; junior women reported high rates of discrimination and harassment, while senior men perceived that the Department of Medicine had achieved gender equity. Conclusions and Relevance:In this study, senior men physicians' perceptions of gender equity were different from lived experiences of gender inequity reported by junior women physicians. This demographic mismatch between perceptions and experiences of gender equity in medicine may explain the lack of action by leaders and decision-makers in medicine to mitigate disparities.

Project description:ImportanceWith increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines.ObjectiveTo examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population.Design, setting, and participantsRepeated cross-sectional study of Association of American Medical Colleges data on self-reported race/ethnicity and sex of medical school applicants and matriculants compared with population distribution of the medical school-aged population (20-34 years). Data from US allopathic medical school applicants and matriculants from 2002 to 2017 were analyzed.Main outcomes and measuresTrends were measured using the representation quotient, the ratio of the proportion of a racial/ethnic group in the medical student body to the general age-matched US population. Linear regression estimates were used to evaluate the trend over time for Asian, black, white, Hispanic, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander medical school matriculants by sex.ResultsThe number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, -0.011; 95% CI, -0.015 to -0.007; P < .001).Conclusions and relevanceBlack, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

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Project description:BackgroundElectronic educational (e-learning) technology usage continues to grow. Many medical journals operate companion blogs (an application of e-learning technology) that enable rapid dissemination of scientific knowledge and discourse. Faculty members participating in promotion and tenure academic tracks spend valuable time and effort contributing, editing, and directing these medical journal blogs.ObjectiveWe sought to understand whether chairs of medicine and pediatric departments acknowledge blog authorship as academic achievement.MethodsThe authors surveyed 267 chairs of US and Canadian medicine and pediatric departments regarding their attitudes toward the role of faculty participation in e-learning and blogging in the promotion and tenure process. The survey completion rate was 22.8% (61/267).ResultsA majority of respondents (87%, 53/61) viewed educational scholarship as either important or very important for promotion. However, only 23% (14/61) perceived importance to faculty effort in producing content for journal-based blogs. If faculty were to participate in blog authorship, 72% (44/61) of surveyed chairs favored involvement in a journal-based versus a society-based or a personal (nonaffiliated) blog. We identified a "favorable group" of chairs (19/59, 32%), who rated leadership roles in e-learning tools as important or very important, and an "unfavorable group" of chairs (40/59, 68%), who rated leadership roles in e-learning tools as somewhat important or not important. The favorable group were more likely to be aware of faculty bloggers within their departments (58%, 11/19 vs 25%, 10/40), viewed serving on editorial boards of e-learning tools more favorably (79%, 15/19 vs 31%, 12/39), and were more likely to value effort spent contributing to journal-based blogs (53%, 10/19 vs 10%, 4/40).ConclusionsOur findings demonstrate that although the majority of department chairs value educational scholarship, only a minority perceive value in faculty blogging effort.

Dataset Information

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010-2020.

Background

Objective

Design

Results

Conclusion

Publications

Gender and Racial Representation Trends Among Internal Medicine Department Chairs from 2010-2020.

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