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

探索内科 ACGME 里程碑绩效评估中的种族/民族偏见

• 批准号: 9894228
• 负责人: Dowin Boatright
• 金额: $ 25.13万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-13 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894228
• 关键词: Academy; Accreditation; Achievement; Address; Adoption; Adult; African American; Asians; Cardiology; Clinical; Community Practice; Competence; Critical Care; Discrimination; Emergency Medicine; Ethnic Origin; Evaluation; Faculty; Foundations; Future; Gastroenterology; Goals; Healthcare; Hematology; Hispanic Americans; Hispanics; Internal Medicine; Intervention; Knowledge; Language; Licensing; Lung; Measures; Medical; Medical Education; Medical Students; Medicine; Minority; Native Americans; Oncology; Performance; Physicians; Primary Health Care; Process; Race; Readiness; Research; Residencies; Risk; Societies; Standardization; Strategic Planning; Structure; System; Talents; Time; Training; Training Programs; Training and Education; United States; United States National Institutes of Health; Woman; base; care outcomes; career; design; education evaluation; ethnic bias; ethnic difference; ethnic health disparity; gender disparity; graduate medical education; health care disparity; health disparity; innovation; medical schools; medical specialties; men; minority trainee; policy implication; programs; racial and ethnic; racial and ethnic disparities; recruit

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.

7.摘要/项目总结 尽管国家做出了努力，但黑人、西班牙裔和美洲原住民医生在医学领域的代表性仍然不足。 以增加医疗保健劳动力的多样性。虽然许多以前的努力，以加强多样性的重点是 增加有才华的少数民族医生申请医学院的管道，仍然需要 解决医学教育中限制多样性的结构性障碍。这一挑战的一个方面是评估 研究生医学教育（GME）实习生绩效评估中是否存在种族/民族偏见， 这可能对医生队伍的多样性构成严重风险。住院医师项目主管使用实习生 评估，为有关晋升和独立执业准备的决定提供信息。同样，实习生 评估形成了选择住院医师进入竞争激烈的临床专科培训的基础 程序.因此，评价方面的差异有可能限制少数群体未来的职业机会 医生在社区实践和学术医学。尽管评价工作十分重要， 居住，有一个研究调查种族/民族和评级之间的关系， 在GME中进行绩效评估。内科（IM）住院医师绩效评估尤其是 重要的是，美国大多数成年初级保健医生完成了IM住院医师和IM住院医师 服务于大多数医学亚专科的门户，许多少数民族医生仍然代表不足。 审查驻地评估是及时的，因为最近认证理事会通过了 基于临床里程碑的研究生医学教育（ACGME）评估系统。里程碑 该系统是全国标准化的，允许对六个区域的驻地业绩进行纵向评价。 在每一年的培训中，都有自己的能力。ACGME里程碑评估的前期研究 来自八个急诊医学住院医师项目的系统显示， 在所有里程碑上的评分都低于男性。到目前为止，还没有研究探讨是否存在类似的差异， 种族/民族。本提案的总体目标是检查所有IM住院医师绩效评估 从2013年到2017年提交给ACGME。该提案的具体目标是：（1）确定 IM居民中种族/民族与里程碑评估评级之间的关系，（2）检查 里程碑评估评级和住院医师项目特定制度因素中的种族/民族差异， 和（3）研究里程碑评估中的种族/民族差异与居民之间的关系 成就我们的研究结果具有许多政策含义，有可能影响如何 医学管理机构评估、提升、招聘和留住少数民族医生。我们的团队包括一个 在与医疗保健劳动力多样性，偏见和歧视相关的问题上， 医学教育，医学教育的评估过程，以及健康和医疗保健的差异 结果。