Academic and professional career outcomes of medical school graduates who failed USMLE Step 1 on the first attempt.

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed. Fifty medical school graduates (2.5 %) initially failed Step 1. Compared to graduates who initially passed Step 1, a higher proportion of graduates who initially failed Step 1 became primary care physicians (26/49 [53 %] vs. 766/1,870 [40.9 %]), were more likely at graduation to report intent to practice in underserved areas (28/50 [56 %] vs. 419/1,939 [ 21.6 %]), and more likely to take 5 or more years to graduate (11/50 [22.0 %] vs. 79/1,953 [4.0 %]). The relative risk of first attempt Step 1 failure for medical school graduates was 13.4 for African Americans, 7.4 for Latinos, 3.6 for matriculants >22 years of age, 3.2 for women, and 2.3 for first generation college graduates. The relative risk of not being specialty board certified for those graduates who initially failed Step 1 was 2.2. Our observations regarding characteristics of graduates in our study cohort who initially failed Step 1 can inform efforts by medical schools to identify and assist students who are at particular risk of failing Step 1.

Examining Black and Hispanic physicians and other healthcare providers' attitudes toward the COVID-19 vaccine.

OBJECTIVES: Recognizing that the voice delivering the message is as important as the information being shared, we examined vaccine perceptions and willingness to encourage patients to obtain COVID-19 vaccinations among Black and Hispanic healthcare providers. METHODS: We conducted a cross-sectional, online survey of Black and Hispanic healthcare providers who were members of the National Medical Association (NMA), National Hispanic Medical Association (NHMA), and National Pharmaceutical Association (NPhA) between January 11 - March 3, 2021, shortly after emergency use authorization (EUA) for the Pfizer and Moderna COVID-19 vaccines. Three multivariable logistic regression models were used to determine factors associated with the willingness to encourage COVID-19 vaccination. RESULTS: The analytic sample consisted of 542 fully completed surveys. Pharmacists reported intent to take the vaccine (75.0% "as soon as you can" vs 91.4% for MD/DOs; p<0.001) and encouraged patients to get vaccinated (78.6% vs 91.0% for MD/DOs; p = 0.01). Providers in a suburban practice location were less likely to recommend vaccines to patients (OR=0.43, 95%CI: 0.22-0.87) and personal family (OR=0.45, 95%CI: 0.22-0.92) compared to those practicing in urban areas. Providers over age 45 were also more likely to report intent to take the vaccine themselves as soon as it was available (OR=3.72, 95%CI: 1.30-10.64). CONCLUSIONS: This is likely the first cross-sectional study in the United States demonstrating the substantial vaccine confidence among Black and Hispanic healthcare providers who serve minoritized communities that have borne the greatest risk of adverse COVID-related outcomes.

Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students.

PURPOSE: To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. METHOD: This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. RESULTS: Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination). CONCLUSIONS: Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.

Differences in the dietary intake habits by diabetes status for African American adults.

BACKGROUND: African Americans (AA) are 1.8 times more likely to develop type 2 diabetes than non-Hispanic Whites. This increased diabetes risk has been linked to high rates of obesity and poor dietary habits; therefore, the purpose of this study is to identify how the nutrient intake profiles of AA adults differ by diabetes status. METHODS: Dietary intakes of AA adults (aged > or =18 years; n=2,589) were examined from the 1999-2004 National Health and Nutrition Examination Survey. Individuals were stratified into three groups (normoglycemia, pre-diabetes, and diabetes) based on self-reported previous diagnosis, blood glucose and use of glucose-lowering medications. Dietary intakes were collected using 24-hour recalls; energy-adjusted nutrients intake were compared across diabetes status. RESULTS: Risk for pre-diabetes was 4% higher for every one year increase in age, while the risk for diabetes was 7% higher. Those with diabetes consumed significantly less energy (P=.03) and significantly more energy-adjusted protein (P=.011) and dietary fiber (P<.001) compared to those with normal blood glucose. Mean consumption of carbohydrates were nearly two and a half times the estimated average requirement regardless of diabetes status. Individuals with diabetes had significantly higher intakes of several B-vitamins including thiamin, riboflavin, niacin, folate and B-6 compared to individuals who had normal blood glucose values. CONCLUSION: This study identifies opportunities for improvement in the dietary habits of African Americans and supports the development of culturally-appropriate diabetes prevention and treatment strategies.

In search of an ADHD screening tool for African American children.

PURPOSE: Behavior rating scales have often been used to evaluate home and classroom behavior for children suspected of attention-deficit/hyperactivity disorder (ADHD). However, there is concern related to the use of behavior rating scales because African American boys and girls are twice as likely to be identified with ADHD behaviors by some of these instruments. This article serves as a brief reference for effectively evaluating African American children for ADHD. METHODS: A MEDLINE search of peer reviewed literature published from 1970 to 2009 was conducted concerning the diagnosis of ADHD in African American children. RESULTS: The majority of ADHD-specific behavior rating scales have face validity based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria. However, with few exceptions, developers of these instruments have failed to use national samples with significant numbers of ethnic minorities to ascertain that screening questions are in fact detecting equivalent behavioral abnormalities across cultures. Fortunately, efforts have been undertaken to validate and improve effectiveness of ADHD-specific behavior rating scales in ethnically diverse populations. CONCLUSION: There are data supporting the use of the Terry and Vanderbilt Attention-Deficit/Hyperactivity Disorder scales for diagnosing ADHD in African American children. Further studies to develop and validate ADHD-specific behavior rating scales for African American children are needed.

Evaluation of a new cultural competency training program: CARE Columbus.

PURPOSE: This article reports the educational outcomes of the newly developed CARE (Cultural Awareness and Respect Through Education) Columbus cultural competency training program. METHODS: Questionnaires were administered to course participants, who completed the 3-hour CARE Columbus cultural competency training program from March 17, 2006, to April 18, 2008. A pilot work site implementation questionnaire was also sent to a smaller sample of participants who completed the course. RESULTS: The CARE Columbus cultural competency training received an overall program rating of 4.5 on a 5-point scale. Sixty-three percent (379 of 601) of the participants completed the program questionnaires. In addition, 55% (33 of 60) of the pilot work site implementation questionnaires were completed. CONCLUSION: Initial evaluation of the CARE Columbus cultural competency training program appears to demonstrate its effectiveness in improving attitudes, knowledge, and skills. Expanded evaluation to include determination of how best to overcome work site implementation barriers is warranted. Future challenges include development of an optimal business plan to maintain sustainability and improve outreach of CARE Columbus and similar classroom style training programs.

Discovering a Hidden Figure of Service and Leadership: The Reverend Charles Edgar Newsome, MD.

Collaborative research between the University School of Medicine Office of Diversity and Inclusion, Health Sciences Library and Department of African and African American Studies recently identified Dr. Charles Edgar Newsome as the institution's first African American physician graduate in 1893. Born May 25, 1856 in the town of Buffalo within Putnam County of Northwest Virginia, he served for 3 years and 6 months as a member of the Regimental Band of the United States Army 25th Infantry, also known as the Buffalo Soldiers, became Grand Master of the Grand United Order of Odd Fellows, and served communities of the state as a reverend, physician, and civic leader. Archival records and photographs uncover the remarkable life of Reverend Charles Edgar Newsome, MD, a hidden figure in history.

Primary Care Provider Understanding of Hair Care Maintenance as a Barrier to Physical Activity in African American Women.

INTRODUCTION: African American (AA) women have reported hair maintenance as a barrier to regular exercise; however, to our knowledge, this study is the first to identify primary care provider thoughts, attitudes, beliefs, and knowledge regarding hair as a barrier to increased physical activity among AA females. METHODS: A 13-question electronic survey was sent via email to 151 clinicians working within a department of family medicine's 8 ambulatory clinics within a large urban academic medical center. RESULTS: A total of 62 primary care clinicians completed the survey, which is a response rate of 41%. The vast majority of respondents (95%) sometimes/often engage in discussions with AA female patients regarding physical activity. However, 76% of respondents have never included a hairstyling or maintenance assessment in that discussion and only 34% noted being comfortable discussing this topic. Among a list of potential barriers to exercise, hair maintenance/scalp perspiration was rarely endorsed as important by clinicians. DISCUSSION: This study highlights a need for increased education among primary care providers regarding AA hair care and maintenance practices as a barrier to increased physical activity in AA women. If specific barriers to increasing healthy habits among AA women are to be addressed, there must be a baseline knowledge of hair care and maintenance barriers, an understanding of the strong influence of cultural norms and practices as it relates to physical activity and exercise, and an increased comfortability when engaging in difficult cross-cultural conversations to ultimately improve health outcomes in AA females.

Progressive lymphadenopathy and intractable pain in an immunocompetent African-American adult with cat-scratch disease.

Persistent, painful cervical lymphadenopathy associated with malaise that does not respond to oral antibiotics may be cat-scratch disease. This condition is challenging to treat and may require surgical intervention. We present a case report of an immunocompetent 47-year-old African-American woman who was diagnosed with cat-scratch disease and hospitalized after multiple outpatient evaluations for progressive, painful lymphadenopathy. This case report outlines the patient's treatment in the author's urban outpatient clinic followed by an inpatient hospital stay with surgical intervention. Although the reported incidence of cat-scratch disease is higher in whites, primary care physicians should include cat-scratch disease in their differential diagnosis for African-American patients with regional lymphadenopathy, which is a hallmark of the disease. In addition, primary care physicians should be familiar with the atypical presentations of cat-scratch disease and the broad differential diagnosis for regional lymphadenopathy, including sarcoidosis, which is more common in African Americans.

Effectiveness of a premedical postbaccalaureate program in improving medical college admission test scores of underrepresented minority and disadvantaged students.

PURPOSE: The purpose of this article is to share the procedures used to strengthen the Medical Pathways (MEDPATH) premedical postbaccalaureate program (PBP) to increase the chances of its students successfully graduating from medical school in four years. METHODS: Subjects included students who matriculated into medical school between 1991-1999 (N = 72) following successful completion of the 12-month MEDPATH premedical PBP. Students who had passed the USMLE Step 1 on the first attempt were defined as successful and were compared to those who did not pass on their first attempt. Programmatic changes were implemented based on these findings, and outcomes were evaluated. RESULTS: There was a significant improvement in total MCAT scores between pre-2003 (PBP entry year) participants (Mn = 20.73, SD = 3.10, N = 117) and post-2003 (PBP entry year) participants (Mn = 25.27, SD = 2.96, N = 37) (t = 7.86, df = 152, p < 0.001). MEDPATH premedical PBP coursework grade-point averages improved from 3.48 to 3.67 over the same time intervals. Diversity of program participants was maintained. CONCLUSION: The enhanced MEDPATH premedical PBP appears to be producing underrepresented minority and disadvantaged medical students who are better prepared to succeed in medical school.

Strategies for Achieving Diversity through Medical School Admissions.

The relative lack of diversity in medicine is a rate limiting factor in efforts to eliminate health care disparities. Many medical schools struggle to matriculate student bodies that reflect the diversity of this country. Actively recruiting is one tactic to diversify a medical school's applicant pool, but in isolation is not enough. Our medical school admissions committee made a number of programmatic changes that contributed to our current compositional diversity that may be instructive to others. This report from the field on the experience of one U.S. medical school describes several admissions committee initiatives that can be undertaken to increase the yield of students from groups underrepresented in medicine who matriculate to medical school.

Implicit Racial Bias in Medical School Admissions.

PROBLEM: Implicit white race preference has been associated with discrimination in the education, criminal justice, and health care systems and could impede the entry of African Americans into the medical profession, where they and other minorities remain underrepresented. Little is known about implicit racial bias in medical school admissions committees. APPROACH: To measure implicit racial bias, all 140 members of the Ohio State University College of Medicine (OSUCOM) admissions committee took the black-white implicit association test (IAT) prior to the 2012-2013 cycle. Results were collated by gender and student versus faculty status. To record their impressions of the impact of the IAT on the admissions process, members took a survey at the end of the cycle, which 100 (71%) completed. OUTCOMES: All groups (men, women, students, faculty) displayed significant levels of implicit white preference; men (d = 0.697) and faculty (d = 0.820) had the largest bias measures (P < .001). Most survey respondents (67%) thought the IAT might be helpful in reducing bias, 48% were conscious of their individual results when interviewing candidates in the next cycle, and 21% reported knowledge of their IAT results impacted their admissions decisions in the subsequent cycle. The class that matriculated following the IAT exercise was the most diverse in OSUCOM's history at that time. NEXT STEPS: Future directions include preceding and following the IAT with more robust reflection and education on unconscious bias. The authors join others in calling for an examination of bias at all levels of academic medicine.

Matching community need with physician training: the OSU Urban Family Medicine Program.

There continues to be a shortage of primary care physicians practicing within urban, Iower-socioeconomic and minority communities despite the fact that many of the 125 allopathic and 19 osteopathic medical schools are located within the affected urban cities. Recognizing a need to better train and recruit primary care physicians to serve in urban settings and provide care to those underserved. The Ohio State Department of Family Medicine established an Urban Family Medicine Residency Program headquartered in Near East Columbus, OH. Starting in 2003, the Urban Family Medicine Residency Program began training up to two residents each academic year. The mission, vision and (curriculum have attracted residency applicants and faculty who have displayed sincere interest and commitment to practicing in urban lower socioeconomic communities.