Factors associated with assessment bias for underrepresented minorities resident physicians training in family medicine and internal medicine

项目摘要 美国的健康差距持续存在，服务不足的人群遭受更低质量的护理， 结果。国家医学领导人呼吁广泛努力招募和培训 医学中代表性不足的少数民族（URM），以提供医生劳动力， 服务不足的社区。虽然URM医学生的招聘人数正在增加，但他们在 医生职业就不那么确定了。对于URM住院医师，研究生医学教育（GME） 由于种族/民族和性别而使偏见永久化的学习环境因素很有可能 阻碍他们的专业发展和留在医学界。其中包括以下方面的必要评估： 住院医师在培训计划中受到评估偏见的影响。全国对GME知之甚少 与URM医生评估偏差相关的学习环境因素，特别是在他们的关键 在成为正式执业医师之前，作为住院医师的成长期。我们的首要目标是 调查影响住院医师培训评估的GME学习环境因素， 初级保健.主要目的是确定和测试URM住院医师中的可修改因素 使用综合的多层次数据集对所有家庭医学和内科GME项目进行培训 来源于国家机构。我们的假设集中在一个多层次的概念模型和初步的数据 这包括在GME学习环境中URM和性别的代表性，以及如何计划- 相关因素可能会影响居民的评估。采用多元Logistic回归和多水平 增长曲线建模，我们将检查URM代表性，性别和计划因素的程度 与评估偏差有关，以及这些因素如何影响 为所有美国居民提供GME认证理事会（ACGME）医生能力的居民学习 接受经认可的家庭医学和内科医学方案的培训。本研究的具体目标是：1） 检查ACGME里程碑评估中是否存在对URM和女性居民的评估不公平 与URM和女教师的代表性有关，2）研究学习的测量 URM和女性居民在ACGME里程碑评估评级中的轨迹与以下因素相关： 程序因素。我们组建了一个医学教育评估，劳动力多样性， 医学教育政策和分析，并期望我们的成果为国家医学领导人提供信息。 教育和初级保健医生队伍规划，以更好地支持URM医生在GME的培训。 这项研究也符合目前的要求，调查结构性障碍，限制初级保健医生 劳动力多样性，并将与NIH健康差异战略计划的承诺，以改善 少数群体的健康，并解决他们的差距。

Project Summary Health disparities persist in the U.S. with underserved populations suffering lower quality of care and worse outcomes. National leaders in medicine have called for widespread efforts to recruit and train underrepresented minorities in medicine (URM) to supply the physician workforce and who can serve underserved communities. Although the recruitment of URM medical students is increasing, their retention in the physician profession is less certain. For URM resident physicians, Graduate Medical Education (GME) learning environment factors that perpetuate biases due to race/ethnicity and gender have high potential to hinder their professional development and retention in medicine. These include required assessments on residents subjected to assessment bias within their training programs. Little is known nationally about the GME learning environment factors associated with URM physician assessment bias, particularly in their key formative years as residents and prior to becoming fully licensed physicians. Our overarching goal is to investigate the GME learning environment factors impacting the assessment of resident physicians training in primary care. The primary objective is to identify and test modifiable factors among URM resident physicians training in all family medicine and internal medicine GME programs using an integrated, multilevel dataset sourced from national bodies. Our hypotheses center on a multilevel conceptual model and preliminary data that includes the representation of URM and gender in the GME learning environment, and how program- related factors may impact the assessments of residents. Using multiple logistic regression and multi-level growth curve modeling, we will examine the degree to which URM representation, gender, and program factors are associated with assessment bias, and how these factors may impact the trajectory of measurements of resident learning in Accreditation Council of GME (ACGME) physician competencies for all U.S. residents training in accredited family medicine and internal medicine programs. The specific aims for this study are 1) examine whether assessment inequities for URM and women residents in the ACGME Milestone assessments are associated with representation of URM and women faculty, and 2) examine how measurements of learning trajectories for URM and women residents in the ACGME Milestone assessment ratings are associated with program factors. We have assembled a team of experts in medical education assessment, workforce diversity, medical education policy, and analytics, and expect our outcomes to inform national leaders in medical education and primary care physician workforce planning to better support URM physicians training in GME. This study also meets current demands to investigate the structural barriers that limit primary care physician workforce diversity and will align with the NIH Health Disparities Strategic Plan’s commitment to improving minority health and address their disparities.