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

7.摘要/项目摘要 尽管国家做出了努力，但黑人、西班牙裔和美国原住民医生在医学界的代表性仍然很低 以增加医疗保健劳动力的多样性。虽然之前许多支持多样性的努力都集中在 增加有才华的少数族裔医生申请医学院的渠道，仍然有必要 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 在研究生医学教育(GME)学员的表现评估中是否存在种族/民族偏见， 这可能会对医生队伍的多样性构成严重风险。实习计划主任使用实习生 评估，为独立执业的推广和准备情况提供决策依据。同样，实习生 评估是选择住院医师参加竞争激烈的临床专科培训的基础 程序。因此，评估方面的差异有可能限制少数族裔未来的职业机会。 社区实践和学术医学方面的医生。尽管评估在以下方面很重要 居住期间，很少有研究调查种族/民族与收视率之间的关系 GME中的绩效评估。内科(IM)住院医师绩效评估尤其 重要的是，因为美国大多数成人初级保健医生都完成了IM住院医生和IM住院医生 它是通往大多数医学子专科的门户，在那里，许多少数族裔医生的代表性仍然不足。 审查居住评估是及时的，因为最近通过了 基于临床里程碑的医学研究生教育评估体系。里程碑 该系统是国家标准化的，并允许对六个城市的居民绩效进行纵向评估 在每一年的培训中的能力范围。ACGME里程碑评估的前期研究 八个急诊住院医生项目的系统显示性别差异，女性接受 在所有里程碑上的评分都低于男性。到目前为止，还没有研究探索是否存在类似的差异 关于种族/民族。本提案的总体目标是检查所有IM派驻人员的绩效评估 2013-2017年提交给ACGME。该提案的具体目的是(1)确定关系 IM居民的种族/民族与里程碑评价评分之间的关系，(2)检验 种族/民族在里程碑评估评级和居住计划特定制度因素方面的差异， (3)考察里程碑评价中的种族/民族差异与居民的关系 成就。我们的研究结果有许多政策含义，可能会影响 医学管理机构评估、提拔、招募和留住少数民族医生。我们的团队包括一名 在与医疗保健人员多样性、偏见和歧视有关的问题上拥有一系列杰出的专家 医学教育、医学教育的评估过程以及健康和保健方面的差距 结果。

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.