Building an Equity-Centered Ecosystem: University of Utah Health as a Microcosm.

Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.

Storylines of family medicine XII: family medicine and the healthcare system.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'XII: Family medicine and the future of the healthcare system', authors address the following themes: 'Leadership in family medicine', 'Becoming an academic family physician', 'Advocare-our call to act', 'The paradox of primary care and three simple rules', 'The quadruple aim-melding the patient and the health system', 'Fit-for-purpose medical workforce', 'Universal healthcare-coverage for all', 'The futures of family medicine' and 'The 100th essay.' May readers of these essays feel empowered to be part of family medicine's exciting future.

Minority Tax on Medical Students: A Review of the Literature and Mitigation Recommendations.

BACKGROUND AND OBJECTIVES: Accreditation standards for MD- and DO-granting institutions require medical schools to recruit a diverse student body and educate students about diverse groups of patients. The minority tax is a summary of responsibilities assigned to racial and ethnic underrepresented faculty to achieve diversity, equity, and inclusion in medical institutions in addition to their typical academic workload. This article provides a narrative review of medical students' experiences of the minority tax and recommendations on how medical educators can support an equitable learning environment by eliminating the minority tax. METHODS: We searched the PubMed, Web of Science, and Scopus databases, Google Scholar, and medical society websites, blogs, and fora for terms, including minority tax, medical students, and undergraduate medical education. We included publications if they discussed the underrepresented in medicine medical students' experiences of the minority tax. RESULTS: Our search yielded six peer-reviewed original research articles and six publications of commentaries, opinion pieces, or news pieces. Students who were underrepresented in medicine reported spending more hours on diversity efforts compared with students who were not underrepresented; moreover, students reported that they had to sacrifice academic excellence in order to fulfill these additional diversity duties. CONCLUSIONS: The minority tax among medical students constitutes an unequitable and unjust barrier to career advancement, and it likely represents an early cause of attrition in the pipeline of underrepresented in medicine academic faculty. Medical educators can enact specific recommendations to eliminate or mitigate the minority tax experience for medical students.

Gearing Up: Accelerating Your CV to Promotion and Tenure.

The curriculum vitae (CV) is an important document for a faculty member and is one of the first documents reviewed by peers or evaluators when a faculty member is being considered for promotion. It catalogs the training history, accomplishments, awards, and productivity of a faculty member over time. Prior work has demonstrated how the CV should be organized and what content should be included. However, no contributions to the literature have discussed how reviewers and other academic leaders view CVs, how to structure CV entries to promote career advancement, and how CVs can become useful or limiting for faculty, regardless of whether a faculty member is actively going through the promotion process. We discuss how the CV can be seen by evaluators and concerns that can cause the CV to decelerate. We then make recommendations on how the CV can accelerate a faculty member toward academic career advancement and promotion.

Writing for Personal and Professional Wellness.

Writing is a part of every academic career in medicine, yet many busy clinicians have difficulty finding time to write and may see it as extra work during their time off. This professional development perspective offers a reframing of writing, not as extra work, but as a wellness activity. The National Academy of Medicine's (NAM) National Plan for Health Workforce Well-being identified seven priority areas where action should be taken to increase wellness in the workforce. Professional writing can "support mental health and reduce stigma" (an explicit NAM priority area) by allowing workers to express gratitude, practice reflection, and write without a deadline. Writing also addresses the NAM priority area of "create and sustain positive work and learning environments and culture" by giving opportunities to support your colleagues, invest in your team, celebrate success, find satisfaction in the sciences, and seek and find healing. By intentionally writing to process emotion and manage work stress, we shift the paradigm for busy clinicians to improve their well-being while simultaneously contributing to academic success.

Underrepresented in medicine (URiM) faculty development: Trends in biomedical database publication.

BACKGROUND: Biomedical databases create an educational platform that allows institutions to share innovations and research discoveries. Identifying literature in biomedical databases that inform the faculty development experiences of faculty underrepresented in medicine (URiM) can help institutions identify resources to promote career advancement for this group. The authors sought to determine biomedical database trends in publications related to faculty development experiences of URiM faculty over the last twenty years. METHODS: An electronic search for literature published between January 2003 to Dec 2022 was conducted in the databases CINAHL, PubMed, Scopus, and PsycInfo using keywords underrepresented minority, faculty development, career development, professional development, academic medicine, and workforce in the title, abstract, or body of the manuscript. Growth rates were calculated for each database. The statistical significance difference in median numbers of publication per database was evaluated using Krusksal Wallis and Dunn's test post hoc. RESULTS: Search results found 1516 publications over the twenty-year period. Scopus published the most literature with 1,372 publications with a mean number of 68.6 per year (SD 83.47). Both Scopus and PubMed had increased growth rates at 41% and 25%, respectively. There were statistically significant differences in median publication numbers between Scopus, CINAHL, and PsycInfo (p < 0.001) but not PubMed (p 0.062). CONCLUSION: Trends in publications related to URiM faculty development have increased over the last twenty years, most noted in the Scopus and PubMed biomedical databases.

Trends Among Women in Academic Medicine Faculty Ranks.

Introduction: Similar proportions of women and men have entered medical school since 2003. However, career advancement and promotion for women continues to be fraught with disparities and inequalities. Building on current literature, this study explores the rates of change of female faculty in faculty ranks over the last 10 years to gain a more comprehensive view of the faculty trends of women in academic medicine. Methods: Using the Faculty Administrative Management Online User System database, counts by gender and faculty rank at each Association of American Medical Colleges (AAMC) academic medical school were obtained. Statistical analysis was done using generalized estimating equations modeling to assess rates of change for each gender from 2012 to 2021. Results: Higher proportions of female faculty are concentrated at the Instructor and Assistant Professor level and lower proportions at the Associate Professor and Professor rank compared to male faculty. Over the study period, female faculty showed increased rate change compared to male faculty of 1.007 (95% confidence interval [CI]: 1.002-1.012) for Associate Professor rank and 1.012 (95% CI: 1.007-1.016) for Professor rank. At the Instructor and Assistant Professor levels, female faculty decreased at a relative rate of 0.980 (95% CI: 0.969-0.990) and 0.995 (95% CI: 0.992-0.997) each year, respectively. Conclusion: Female faculty continue to be concentrated at the junior faculty rank. Rate changes at the senior faculty rank for female faculty have slightly improved over the last 10 years compared to male faculty. However, this improvement is minimal, and work is still needed to achieve true gender equity in academic medicine.

Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study.

PURPOSE: The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). METHODS: Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. RESULTS: Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. CONCLUSIONS: Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.

Failure to Participate in Sports: An Evaluation of Preparticipation Physicals in a Local School District.

PURPOSE: To determine the incidence of the documentation of athlete failure of preparticipation sports physicals. METHODS: This was a retrospective observational study that involved review of preparticipation examination physical form documentation from multiple clinicians for all student athletes who participated in athletics during the 2018 to 2019 academic year at Galveston Independent School District (GISD). We collected the reasons for failure to pass the preparticipation physical examination. RESULTS: Of the approximately 800 student athlete forms reviewed, 183 forms indicated individual athletes failed the visual acuity or cardiovascular portions of the preparticipation physical examination. DISCUSSION: Athlete failures of the preparticipation physical examination may cause delays in sports participation, and time and monetary costs to students and their parents. Inconsistences in guidelines used to clear athletes as well as variation in form completion impacts whether athletes reportedly failed or passed the examination. Mass participation screening becomes a safety net for communities for athletes who may not have primary care providers to encourage follow-up with a regular clinician for previously undiagnosed medical issues and standardizing guideline use and form completion across clinicians who do these exams may improve numbers of athletes who are cleared to play sports. CONCLUSION: Focusing on preventable and addressable preparticipation examination failures may help clinicians who perform these exams, while also establishing a safety net for previously undiagnosed medical conditions. Instituting yearly vision checks, addressing cardiovascular issues, and encouraging yearly follow-up with primary care clinicians can more readily address physical and mental health issues and will provide more comprehensive care to student athletes.

Overcoming Mission Competition in Departments of Family Medicine.

Departments of family medicine are centered around the tripartite mission of education, research, and clinical care. Historically, these three missions have been balanced and interdependent; however, changes in the funding and structures of health systems have resulted in shrinking education and research missions and an increased emphasis on clinical care. In the wake of waning state and federal contributions to primary care research, many departments of family medicine have adopted a private practice approach. This approach is centered on generating revenue for the institution, incentivizing physicians to remain clinically focused through productivity and intense attention to volume targets. As a department's focus shifts to the clinical care mission, education and research are increasingly neglected and underresourced. Meanwhile, the administrative burden of electronic health records (EHRs) has further encroached on time previously allocated to research, with the EHR burden disproportionately affecting the primary care workforce. To counteract mission competition in departments of family medicine and to recover the vital missions of education and scholarship, devising a clear plan for reclaiming and sustaining a tripartite mission is important. Advocating for increased primary care research funding, enhancing EHRs, balancing clinical and education metrics, and supporting primary care research, especially for groups underrepresented in medicine, are interventions to help fully support education and research missions and to recover and sustain mission balance in departments of family medicine.

Are committee experiences of minoritized family medicine faculty part of the minority tax? a qualitative study.

BACKGROUND AND OBJECTIVES: Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity "check box," and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax. METHODS: Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods. RESULTS: Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement). CONCLUSIONS: Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows' URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

The Relationship Between the Social Mission Content of Medical School Mission Statements and Minority Faculty Representation Among Faculty and Senior Leadership.

Medical schools with social missions have the potential to increase minority student interest in health disparities research. In previous work, the authors looked at the missions of medical schools to determine if they were associated with minority student representation. In this paper, the authors look at the representation of full-time faculty and senior leaders who are underrepresented in medicine in US medical schools. This study included all MD-granting medical schools in the US with available data on mission statement Social Mission Content (SMC) and faculty demographics. Data were analyzed for representation of faculty underrepresented in medicine (URM) among all faculty, among junior as compared to senior faculty, and among department chairs. In the 2013 data, Pearson correlation coefficients were calculated to characterize the association between SMC and contemporaneous URM faculty representation. In the 2014-2020 data, hierarchical linear models were used to estimate the association between SMC and the annual rate of change in URM faculty representation. In 2013, URM faculty accounted for 7.4% of all faculty at the median medical school, increasing to 8.4% in 2020. As of 2013, URM representation among junior faculty was 9.2% at the median school, 5.6% among senior faculty, and 4.3% among department chairs. The authors found a slow increase in the percentage of URM faculty members (but not department chairs). This trend did not vary between schools with lower vs. higher emphasis on a social mission (based on the mission statement). The increase in chair representation was determined to be associated with the type of the school, whether historically Black or Puerto Rican, and not precisely its mission.

Future Doctors From Underrepresented in Medicine Communities at the University of Utah.

Background and Objectives: Future Doctors (FD), a high school pathway program, was developed to address the lack of compositional diversity in the health professions at our health sciences campus. Methods: We obtained, analyzed, and compared data on FD student demographic and educational achievement at undergraduate and graduate programs at the University of Utah and graduate programs at other institutions to non-FD students. We followed students from high school to graduate school. Results: We analyzed data from 1,897 FD participants (2014-2019). FD participants were 71% women, with 50.3% identifying as students of color. Ninety-eight students matriculated in graduate school, with 75 (76%) remaining at University of Utah and 45 (46%) attending health sciences graduate programs. Conclusions: FD student cohorts are more diverse than those in the University of Utah undergraduate and graduate programs, contributing to the diversity of those programs. More research is needed to ensure that graduate school gains are evidenced in all underrepresented groups.

Changing Missions of Medical Schools and Trends in Medical Student Diversity.

BACKGROUND AND OBJECTIVES: Improving diversity in the physician workforce continues to be a challenge and a priority for medical schools. Establishing a school-wide mission statement that addresses diversity, equity, and inclusion can help support efforts to increase the number of underrepresented in medicine (URM) graduates. METHODS: In this study, we analyzed changes in medical school mission statements between 2013 and 2021 and correlated changes in mission statements with trends in URM student representation. We performed a web search of 136 medical schools' mission statements and categorized them based on whether they changed their mission statement to add diversity or equity language. We then obtained demographic data of enrolled students at each school and identified the percentage of students identifying as URM in each academic year. We used mixed-effects regression and pair fixed effects linear regression to examine trends in URM student representation and the association between URM student representation and whether a school added diversity and equity content to its mission statement. RESULTS: We found that URM student representation increased by 0.4% per year at schools that added diversity and equity content to their mission statements. CONCLUSIONS: Changing medical schools' mission statements to reflect values of diversity, equity, and inclusion was associated with an increase of less than a 1% per year in URM representation. More research is needed to explore relationships between URM representation and medical school mission statements.

Resident Self-assessment and Clinical Competency Committee Evaluations in Family Medicine: A Single-Institution Study.

BACKGROUND AND OBJECTIVES: We sought to describe the process of integrating resident self-assessments into milestone assessments at the University of Texas Medical Branch Family Medicine Residency Program in Galveston, Texas. We compared resident self-assessments across milestones to Clinical Competency Committee (CCC) assessments across terms (fall versus spring) and by postgraduate year (PGY). METHODS: In fall 2020, the milestone assessment process was updated to include a resident milestone self-assessment, which was used as the starting point for CCC assessment. We calculated mean and standard deviation of average milestone scores for both self-assessment and CCC for each PGY. We used repeated measure analysis of variance to examine within- and between-subject effects. RESULTS: Self-assessment and CCC assessments were completed for 30 postgraduate trainees for spring 2020 and fall 2021 terms, for a total of 60 self- and 60 CCC assessments. CCC score was similar to self-assessment. There were larger variations in the resident self-assessment scores than CCC scores. Self-assessment scores increased by PGY, but were not different between fall and spring terms. We found a significant three-way interaction of assessors, terms, and PGYs. CONCLUSIONS: Resident milestone self-assessment enables residents to participate in the assessment process, and when differences exist between self- and CCC assessments, specific feedback can be given based on individual milestone skills. Our study showed progression between PGY regardless of the assessor, but only CCC assessment showed significant differences between terms.

Increasing Underrepresented Minority Students in Medical School: a Single-Institution Experience.

PURPOSE: Underrepresented minority student recruitment initiatives from medical school admissions and diversity offices can bring equity for those learners underrepresented in medicine. Measuring growth of the applicant pool helps determine the impact of such initiatives in helping diversify the healthcare workforce. AIM: The authors evaluated underrepresented minority applicant pool growth at the Brody School of Medicine to determine whether predominantly White institutions or historically Black colleges and universities have accounted for the most growth in minority applicants in recent years. METHODS: Outreach outcomes across the state were obtained by comparing applicant and matriculant demographics. Data on all applicants and matriculants were retrieved from the school's institutional records and classified according to student self-identification as underrepresented minority. Using Chi-square tests, authors aimed to determine whether the proportion of minority students increased among applicants and matriculants since 2016, the year of restructuring outreach. In further analysis, the number of graduates from historically Black colleges and universities as compared to minority graduates from predominantly White schools was evaluated. RESULTS: The authors identified 7,848 applicants and 654 matriculants over the evaluation period. The proportion of learners identifying as underrepresented minority increased from 17% before 2016 (622/3,672) to 20% after 2016 (835/4,176; p = 0.001). The proportion of applicants who did not graduate from a historically Black college or university increased slightly after 2016 (89% of underrepresented minority applicants before 2016 vs. 92% of underrepresented minority applicants after 2016), but this increase was not statistically significant (p = 0.097). CONCLUSION: Applicant growth has been more significant for underrepresented minority applicants from predominantly White institutions. Graduates of targeted historically Black colleges and universities who applied to Brody School of Medicine were better prepared, resulting in increased chances of admission.

Pseudoleadership as a contributor to the URM faculty experience.

Pseudoleadership for faculty underrepresented in medicine (URM) has been defined as when URM faculty are placed in leadership positions only because of the racial and ethnic diversity they bring, when they are not ready or trained for such roles because of being early in their faculty careers. It occurs when senior leaders push early career URM faculty into spaces where it is difficult for them to be successful.  Pseudoleadership can open up URM faculty to manipulation by superiors and impact URM advancement, as work of leadership positions take time away from scholarship and other activities which institutions value for promotion. Pseudoleadership is typically a problem for early career URM faculty and can be seen when ranks such as lecturer or assistant professor are placed in leadership or other administrative positions without careful thought on how to support the advancement and promotion of this group. In this manuscript the authors discuss pseudoleadership, its impact on the advancement and development of faculty who are underrepresented in medicine and a path forward.

Mitigating the Isolation of Minoritized Faculty in Academic Medicine.

Increasing numbers of faculty who are underrepresented in medicine has been a focus of academic health systems. Understanding the experiences of these faculty helps in creating environments that are inclusive and supportive, promoting faculty success. When compared with non-minoritized faculty, minoritized faculty face racism, isolation, diversity efforts disparities, clinical efforts disparities, lack of faculty development, and promotion disparities. While there have been contributions to the literature to better characterize disparities faced by minoritized faculty, little has been written about isolation. Isolation occurs when faculty underrepresented in medicine do not feel like part of the department or institution. They may feel excluded from mainstream culture as if they are invisible. They may be excluded from conversations, group chats, get togethers, or other work-related or social functions. These feelings can manifest as imposter syndrome and impact work performance and decision-making. In this article, the author shares how to recognize and mitigate isolation to promote an inclusive environment for all faculty.