Exploring Racial/Ethnic Bias in Internal Medicine ACGME Milestone Performance Evaluations

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7. ABSTRACT/ PROJECT SUMMARY Black, Hispanic, and Native American physicians remain underrepresented in medicine despite national efforts to increase diversity in the healthcare workforce. While many prior efforts to bolster diversity have focused on increasing the pipeline of talented minority physicians applying to medical school, there remains a need to address structural barriers in medical education that limit diversity. One aspect of this challenge is assessing whether there is racial/ethnic bias in graduate medical education (GME) trainee performance evaluations, which could pose a critical risk to physician workforce diversity. Residency program directors use trainee evaluations to inform decisions regarding promotion and readiness for independent practice. Similarly, trainee evaluations form the basis for selection of residents into highly competitive clinical sub-specialty training programs. Therefore, disparities in evaluations have the potential to limit future career opportunities for minority physicians both in community practice and academic medicine. Despite the importance of evaluations during residency, there is a paucity of research investigating the relation between race/ethnicity and ratings on performance evaluations in GME. Internal Medicine (IM) residency performance evaluations are especially important as the majority of adult primary care doctors in the US complete an IM residency and IM residency serves a gateway to most medical subspecialties, where many minority physicians remain underrepresented. Examining residency evaluations is timely because of the recent adoption of the Accreditation Council of Graduate Medical Education's (ACGME's) evaluation system based on clinical milestones. The milestone system is nationally standardized and allows for longitudinal evaluation of resident performance across six domains of competency throughout each year of training. Prior research of ACGME's milestone evaluation system from eight Emergency Medicine residency programs revealed gender disparities with women receiving lower ratings than men on all milestones. To date, no studies have explored if a similar disparity exists based on race/ethnicity. The overall goal of this proposal is to examine all IM residency performance evaluations submitted to the ACGME from 2013-2017. The specific aims of the proposal are to (1) determine the relation between race/ethnicity and milestone evaluation ratings among IM residents, (2) examine the relation between racial/ethnic differences in milestone evaluation ratings and residency program-specific institutional factors, and (3) investigate the relation between racial/ethnic differences in milestone evaluations and resident achievement. Results from our study have numerous policy implications with the potential to influence how governing bodies in medicine evaluate, promote, recruit, and retain minority physicians. Our team includes an outstanding array of experts in issues related to healthcare workforce diversity, bias and discrimination in medical education, evaluation processes in medical education, and disparities in health and healthcare outcomes.