Asthma morbidity measures across Black ethnic subgroups.

BACKGROUND: Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE: We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS: Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS: Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS: ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.

Correlates and trends in training satisfaction on completion of internal medicine-pediatrics residency: a 5-year study.

OBJECTIVE: To examine trends in training satisfaction in graduates of combined internal medicine-pediatrics (Med-Peds) training programs and whether curricular elements designed to enhance the integration of the two disciplines have been successful. STUDY DESIGN: We conducted a cross-sectional survey of all graduating Med-Peds residents (years 2003-2007). Responses across survey years were analyzed to identify trends. Data for all survey years was analyzed for correlations among curricular elements, perceived adequacy of training, and preparation for future activities. RESULTS: Overall, residents rated training time as just right for all areas except neonatal intensive care unit training, outpatient procedures, career planning, and office management. There was a significant upward trend in availability of board examination reviews, Med-Peds noon conferences, and mentoring. Residents' ratings of their preparation for most activities increased across the years. More residents reported being satisfied with preparation for internal medicine than pediatric primary care practice (86% versus 83%). Career planning seminars, mentoring, and board reviews correlated with the greatest increase in satisfaction. CONCLUSIONS: Med-Peds graduates report a high and increasing level of satisfaction with their preparation in multiple educational domains. Curricular elements designed to enhance integration of the two disciplines have a broad positive impact. Perceived pediatric practice preparation lags behind that of internal medicine.

The effect of dual training in internal medicine and pediatrics on the career path and job search experience of pediatric graduates.

OBJECTIVE: To compare the job search experience and career plans of medicine-pediatrics (med-peds) and pediatric residents. STUDY DESIGN: Annual surveys of graduating med-peds and pediatric residents were compared from 2003 and 2004. RESULTS: The survey response rates were 58% for med-peds residents (n = 427) and 61% for pediatric residents (n = 611). Pediatric residents were more likely to be female or an International Medical Graduate. The groups were equally satisfied with their career choice and had equivalent debt. Med-peds residents were more likely to seek and accept generalist and hospitalist positions. Pediatric residents were more likely to seek subspecialty careers and research opportunities. More than 94% of med-peds residents expected to care for pediatric patients. Among residents seeking generalist positions, med-peds residents sent half as many applications to get the same number of interviews and offers as pediatric residents, were more likely to be offered their most desired position, and were more likely to accept a position in a rural area/small town. Med-peds residents had substantially greater starting salaries as hospitalists or generalists compared with pediatric residents. CONCLUSION: Med-peds and pediatric trainees differ in their career plans, although primary care is their most popular choice. Med-peds- trained physicians have an easier job search experience and greater market valuation.