Undergraduate College Pathway Programs Designed to Attract and Matriculate Students from Underrepresented Groups into Medicine.

OBJECTIVES: Undergraduate college pathway (or pipeline) programs support students' interests as they explore advanced degree and career pathways. Many programs aim to diversify the medical workforce by reducing barriers that may have otherwise prevented desired academic and career goals; however, variability in structure, expectations, benefits, and outcome data exist. This systematic review was conducted to identify and evaluate undergraduate college pathway programs designed to increase the diversity of medical school matriculants. METHODS: We searched Ovid Medline, PsycInfo, Scopus, and the Education Resources Information Center for peer-reviewed, original research publications (1996-2019) describing US pathway/pipeline programs designed for undergraduate-level college students from underrepresented groups to apply and enter medical school. Data extraction included application processes, participant demographics, curricular components, social support systems, mentorship, funding, and program/participant outcomes. We reviewed the journal impact factor to inform us about where articles are being published. RESULTS: Our full-text review included 137 articles; 25 articles met the inclusion criteria. All of the papers were descriptive, requiring an application, minimum grade point average, letters of recommendation, and personal statements. All of the programs aimed to diversify medicine, yet some could not request identification of race/ethnicity because of changes in affirmative action or legal restrictions when reporting demographics. Women represented the majority of enrollees. The program length varied; all reported having one or a combination of academic enrichment, research, field observation/experience, and mentorship. All of the programs included career development and various supplemental social supports. Only two programs provided comparison data; four reported no outcomes. CONCLUSIONS: Pathway programs support the acquisition and enhancement of professional skills. Lacking longitudinal or comparison data leads to questions of the long-term impact on diversifying the medical workforce. This article highlights a need for rigorous data collection methods and transparent reporting of participant outcomes to inform programmatic efficacy.

Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC): Diversifying the Clinical Cancer Research Workforce.

A lack of diversity in the clinical cancer workforce causes undue burden limiting research and patient care advancements. Recruitment and retention of individuals underrepresented in medicine/research can enhance patient-provider concordance. The Student-centered Pipeline to Advance Research in Cancer Careers (SPARCC) uniquely prepares underrepresented minority students to quickly transition into the clinical research workforce and seek advanced graduate degrees. Experiential learning theory and culturally responsive pedagogy ground SPARCC's rigorous competency-based curriculum incorporating cancer care, clinical trial development, social supports, and mentored research experiences. Concurrent mixed-methods analysis includes evaluations of workshops, clinical-practicums, and pre-, post-, and 6-month-post-knowledge, attitudes, and practices. Analysis of data included stepwise multivariate regression analysis, Spearman's rho correlations, and assessments of inter-item reliability via Cronbach's alpha (IBM® SPSS® 24.0). Inductive content analysis coded phrases and analytic patterns were distilled enhancing descriptions of experiences. From January 2019 to March 2019, 62% of applications came from underrepresented minorities. Ten students were accepted, 90% identified as underrepresented minority. All ten students completed the pre-, post-, and 6-month-post-evaluations. Overall scores increased significantly from pre-evaluation to 6-month-post-evaluation. Evaluation data came from 431 responses of 60 workshops, with a mean score of 9.1 (10-point scale). Students completed three clinical practicums, which received an overall mean score of 8.2 (10-point scale). A robust curriculum, structured recruitment, diverse faculty, and comprehensive evaluations made SPARCC a compelling strategy for supporting underrepresented minority students to seek immediate employment as clinical research professionals or application to advanced graduate degree programs.

Intersecting gender, evaluations, and examinations: Averting gender bias in an obstetrics and gynecology clerkship in the United States.

BACKGROUND: The purpose of this study was to determine whether gender bias was present in the final third-year medical student obstetrics/gynecology clerkship performance evaluation completed by faculty and resident physicians. METHODS: This was a retrospective cohort study of third-year medical students over the course of ten years (2004 - 2014) at a private medical school in the northern US state of Wisconsin. Each student's performance during their required 6-week obstetrics/gynecology clerkship was assessed by a combination of the student's scores on a clinical performance evaluation and on a standardized national subject examination. The clinical performance evaluations are comprised of 10 domains, each using a 9-point Likert scale and completed by faculty and resident physicians. All clerkships at our institution use the same evaluation form, which was designed and validated by the medical education statistics department. Final obstetrics/gynecology clerkship average clinical evaluation scores (Scale 1-9) and obstetrics/gynecology standardized national subject examination scores (Percentile 1-99) were compared to see if a gender based difference between subject examination and performance evaluation scores existed. RESULTS: 1,976 student records were analyzed. Mean standardized national subject exam scores were significantly higher for females [74.4 (8.1)] than males [72.9 (8.2)] (Possible range 1-99) with Cohen's d = 0.2 (P = 0.001). The average female score on the clinical evaluation was mean (SD) = 7.4 (0.9), compared to an average clinical evaluation score of 7.2 (1.0) for males (P = 0.001) (range 1-9). Performance on the standardized national subject exam was significantly correlated (r = 0.3, P = 0.001) with clinical evaluation scores, and when split by gender the strength of the correlation remained. DISCUSSION: Medical student performance on the standardized national subject exam correlated with clinical evaluations independent of gender. Women had higher scores on both the subject examination and the clinical performance evaluations. There was no evidence of gender bias in the students' clinical evaluation scores.

Development of a New Resident-Centric Sex Trafficking Education Program for Obstetrics/Gynecology, Emergency Medicine, and Family Medicine Programs.

Introduction: Human sex trafficking is widespread and a nationally recognized public health crisis. Trafficked individuals and survivors often utilize the healthcare system, yet healthcare professionals cite a lack of formal training to identify and provide appropriate care. This study aims to increase obstetrics/gynecology, emergency medicine, and family medicine residents' knowledge and confidence when caring for individuals involved in sex trafficking. Methods: Obstetrics/gynecology, emergency medicine, and family medicine residents voluntarily attended an evidence-based education session and received an electronic pre-, immediate post-, and 5-month post-session survey measuring knowledge, attitudes, beliefs, and confidence. Validated survey items were adapted from previous studies. Paired t-tests (p<0.05) and descriptive analyses were used to determine differences. A concluding focus group was facilitated to further understand trainee experiences and awareness when caring for suspected sex-trafficked individuals and survivors. Thematic analysis determined reoccurring themes. Results: Between 2019 and 2021, 48 pre-session, 28 immediate post-session, and 13 5-month post-session surveys were collected. Resident knowledge and confidence increased from the pre-session to the immediate post-session period. Session pre- and post-surveys were linked (n=14) and showed a statistically significant increase in knowledge (p<0.05) and an increase in confidence. The mean number of correct knowledge questions remained higher 5 months after the session than in the pre-session period. Focus group themes included increased resident knowledge and confidence. Conclusions: Improvement and retention in resident knowledge and confidence in caring for sex-trafficked individuals illustrate the utility of this education intervention and expand on current literature. This study provides an example of an education session that can be adapted for other medical trainees.

Medical students and mattering on the surgery clerkship rotation.

BACKGROUND: Mattering is a psychosocial construct that describes an individual's perception that they make a difference in the lives of others and that they are significant in the world. The purpose of this study was to explore the current perception of behaviors that impact mattering among third year medical students on their surgery clerkship with the goal of improving the clerkship experience. METHODS: A qualitative interview study was conducted during the 2019-2020 academic year. Medical students who had completed their surgery clerkship at a single institution volunteered to participate. Qualitative thematic analysis of students' comments during interviews were categorized to the three primary domains of mattering: awareness, importance, and reliance. RESULTS: Six medical student interviews were conducted and responses were coded for the three primary domains of mattering. Eight subthemes emerged highlighting positive observations that may influence student mattering on the surgery clerkship. Awareness behaviors included acknowledging the student's presence, maintaining eye contact, educators offering students their undivided attention, and getting to know the students as individuals. Importance behaviors included taking time to teach, setting expectations early, and providing timely feedback. Reliance behaviors involve developing trust to match autonomy with experience and depending on students to provide unique information about patient care to the team. CONCLUSIONS: These findings can help educators recognize the words, actions, and behaviors that make medical students feel they matter on their surgery clerkship. Interventions should continue focus on how to increase the sense of awareness, importance, and reliance for both the students and faculty.

The Effect of COVID-19 on the Medical School Experience, Specialty Selection, and Career Choice: A Qualitative Study.

OBJECTIVE: While COVID-19 had a profound impact on healthcare, its effects on medical students are less clear. This study explored the effects of COVID-19 safety measures on medical students' specialty selection and career choices. It further considers the potential differential effects of COVID by gender. DESIGN: Between June and November 2020 at a Midwestern medical university, medical students with an anticipated graduation in 2021 through 2023 participated in virtual focus group sessions, which explored students' transition to remote learning during COVID-19, perception of gender bias within medical education, and personal and professional goals. Nine focus groups were held, with two to six students per session (n = 22). Focus groups were video recorded, transcribed verbatim, and data were deidentified. Transcripts were coded and analyzed using consensual qualitative analysis to identify themes. RESULTS: Our analysis captured 3 themes: (1) Impact of Institutional Decision-Making due to COVID-19, (2) Impact of Unstructured Time on Professional and Personal Decision Making, and (3) Impact of Societal Pressures, Gender Bias, and Mentorship on Career Planning. CONCLUSIONS: COVID-19 disrupted important learning opportunities for medical students. Mentorship and shadowing are critical in helping students make career and specialty decisions, particularly for women. The loss of these opportunities may have lasting career impacts for all students.

Winners and Losers in Academic Productivity During the COVID-19 Pandemic: Is the Gender Gap Widening for Faculty?

Background: The coronavirus pandemic accelerated academic medicine into the frontline of research and clinical work, leaving some faculty exhausted, and others with unanticipated time off. Women were particularly vulnerable, having increased responsibilities in both academic work and caregiving. Methods: The authors sought to determine faculty's responses to the pandemic, seeking predictors of accelerated versus decelerated academic productivity and work-life balance. In this survey of 424 faculty from a private Midwest academic medical center completed in August-September 2020, faculty rated multiple factors both "pre-COVID" and "during the COVID-19 lockdown," and a change score was calculated. Results: In a binary logistic regression model comparing faculty whose self-rated academic productivity increased with those whose productivity decreased, the authors found that controlling for multiple factors, men were more than twice as likely to be in the accelerated productivity group as women. In a similar model comparing partnered faculty whose self-rated work-life balance increased with partnered faculty whose work-life balance decreased, being in the positive work-life balance group was predicted by increased academic productivity, increased job stress, and having higher job priority than your partner. Conclusions: While the COVID-19 pandemic placed huge stressors on academic medical faculty, pandemic placed huge stressors on academic medical faculty, some experienced gains in productivity and work-life balance, with potential to widen the gender gap. As academic medicine evolves post-COVID, leaders should be aware that productivity and work-life balance predict each other, and that these factors have connections to work location, stress, and relationship dynamics, emphasizing the inseparable connections between work and life success.

Leadership Views on the Barriers and Incentives to Clinical Preceptorship.

BACKGROUND: Clinical education often relies on a one-to-one student-preceptor model. Recruiting and retaining quality preceptors to sustain this model has become increasingly difficult at academic institutions across the nation. While ample literature describes preceptor barriers and incentives as viewed by physician educators, few studies explore the issue from institutional leadership perspectives. OBJECTIVES: This study aimed to describe leadership perceptions across an academic institution to better understand knowledge gaps, system barriers, and proposed solutions to help institutions take action and address preceptor shortages. METHODS: Between February and July 2019, the researchers conducted one-on-one semi-structured interviews with sampled representation of Medical College of Wisconsin leadership. The researchers reviewed transcriptions of each interview verbatim and used a qualitative grounded theory approach to generate content codes and themes. Researchers iteratively refined codes using the constant comparison method until all interviews were analyzed and final themes and subthemes were defined. RESULTS: Twelve institutional leaders participated, of whom 5 were clinical executives, 1 was an academic executive, 4 were academic deans, and 2 were educational directors. Analysis yielded 4 major themes: student impact, recognition, physician well-being, and leadership. CONCLUSION: Each content theme highlighted areas to consider when addressing preceptor issues within an institution: (1) leadership knowledge gaps regarding the scope of preceptor challenges, particularly time commitments and the number of preceptors required; (2) improving career advancement or promotion criteria to recognize teaching efforts; (3) enhanced physician well-being from teaching, while important, may no longer be sufficient for participation, especially without financial compensation; (4) distributed leadership may be needed to address issues at the course, clinic, and system levels.

Gendered Differences in Teaching Performance Evaluations of Obstetrics and Gynecology Residents.

OBJECTIVE: Teaching performance evaluations are commonly used for career development and advancement. Due to possible gendered expectations, implicit or explicit bias may emerge in evaluations completed by learners. This study investigated how third-year medical students evaluated teaching performance of obstetrics and gynecology resident physicians based on resident gender. SETTING: This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin. DESIGN: This retrospective mixed methods study examined teaching performance evaluations of obstetrics and gynecology resident physicians from 2010 to 2018, completed by third-year medical students. A two-sample, two-sided t-test was used to compare numerical scores. Deductive content analysis of written comments focused on specific categories: positive or negative agentic or communal demeanors and characteristics, teaching skills, character and professionalism, leadership abilities, clinical skills and knowledge, and frequency of words and phrases used to describe residents. SETTING: This study was conducted at the Medical College of Wisconsin in Milwaukee, Wisconsin. RESULTS: Of 83 residents (71 females, 12 males), there was no statistical significance in the teaching performance evaluation scores between male and female residents (n = 10,753 total completed evaluations). Female residents had lower scores than male residents; males tended not to score below 4 (5-point response scale; 5 = outstanding). Of 3,813 written comments, male residents had more positive comments, with statistical significance in communal characteristics (71.4% male, 53.9% female, p = 0.01). Female residents received more negative comments, with statistical significance in communal characteristics (7.5% female, 2.8% male, p = 0.01). Frequency of words presented that male residents had more "standout" traits ("outstanding," "excellent," "exemplary"), "ability" terms ("intelligent," "bright," "talented," "smart"), and were often considered "fun," "funny," and "humorous." Female residents were described by "compassion" terms ("kind," "compassionate"). CONCLUSION: Student-completed teaching performance evaluations are a valuable assessment of teaching skills and influence department recognition, award distribution, fellowship and employment opportunities. This study found that medical students did evaluate female residents differently than male residents. Understanding gendered expectations may assist in findings ways to address discrepancies between male and female physician evaluations.

The Adaptive Learner: How Faculty and Medical Students' Perceptions of Learning Needs and Desires Differ.

PROBLEM CONSIDERED: Medical schools historically have utilized instructor-centered lectures to teach medical students the basic sciences. Several commercial electronic-based resources are now available to enhance lecture-based content. This study examines perceptions between students and faculty regarding the efficacy of lecture-based teaching and learning strategies used by students overall. RESEARCH METHODS: The authors distributed surveys to medical students and basic science teaching faculty at the Medical College of Wisconsin. Survey items used categorical and 10-point scales and open-ended text response. Mean scores were compared with independent t tests and Cohen d effect sizes. Pearson (r) and Spearman rho (ρ) correlations were used for relational analysis. IBM SPSS 24.0 was used for statistical analysis, NVivo 11 was used for qualitative analysis. RESULTS: Faculty's perception of meeting students' learning needs was rated significantly higher (mean [SD] = 7.3 [1.3]) than students (5.9 [2.0]) (Cohen d = 1.0/P < .001). There was a significant negative correlation between lectures meeting students' learning needs and time students spent outside of lecture seeking supplemental learning resources (ρ = -0.4/P < .001). Students highlighted their use of personal learning strategies, desire for equitable access to resources, and preparation for national board examinations. Faculty emphasized their perceptions of learning resources, recognition of learning styles, time restrictions, and desire to utilize diverse teaching methods. CONCLUSIONS: Student and faculty perceptions regarding student learning needs were significantly different. Students use lectures extensively, but additionally add to the financial burden of medical school by personally funding supplemental resources. This study helps bridge the gap between medical students and faculty regarding what educational tools are best suited to support a student population with increasingly diverse learning needs.

Secondary Traumatic Stress in Ob-Gyn: A Mixed Methods Analysis Assessing Physician Impact and Needs.

OBJECTIVE: This study aims to evaluate the incidence of secondary traumatic stress in Obstetrics and Gynecology physicians including symptoms, impact, and programmatic needs for support. DESIGN: This study used a mixed-methods approach comprised of an anonymous online survey and individual interviews/focus groups. IBM SPSS 24.0 generated statistical analysis: descriptive statistics, Fisher's exact test to compare nominal survey data and across groups, phi correlations (ϕ) and interitem reliability (Cronbach alpha). Constant comparative qualitative analysis determined cross-cutting themes. Research was approved by institutional IRB. SETTING: This study was conducted at the Medical College of Wisconsin, Milwaukee, Wisconsin, a large academic medical institution. PARTICIPANTS: Participants were recruited from the Department of Obstetrics & Gynecology via email. Faculty, fellows, and residents participated in an anonymous online survey and were invited to complete individual interviews or focus groups. The online survey was distributed to 67 clinical faculty, residents, and fellows with a total of 27 individuals completing the reliable (alpha = 0.71) anonymous survey (40% response rate). Ten faculty participated in individual interviews or focus groups. RESULTS: Respondents to the quantitative survey identified involvement in adverse medical events (95%) and symptoms of traumatic stress (75%). Anxiety (81%), guilt (62%), and disrupted sleep (58%) were most frequently reported symptoms (mean number of symptoms = (3.4(±2.1)). Individuals reporting anxiety were more likely to seek support from colleagues (ϕ = 0.5, p < 0.006); those reporting guilt would go to friends (ϕ = 0.5, p < 0.007). Disrupted sleep more commonly led to seeking mental health services (ϕ = 0.5, p < 0.007). Desire for support varied. Those reporting anxiety were interested in peer-to-peer responders (ϕ = 0.6, p < 0.001); those reporting guilt would use debriefing sessions (ϕ = 0.4, p < 0.023). Qualitative data from individual interviews and focus groups yielded descriptions of physical and cognitive symptoms associated with second victim experiences included responsibility, guilt/shame, self-doubt, anxiety/rumination and sleep disturbance. Identified resources for coping: just culture, collegial support, peer-to-peer responders, and structured case conferences for emotional debriefing. CONCLUSIONS: Obstetrics and Gynecology providers are likely to experience symptoms of secondary traumatic stress following adverse patient events similar to other medical specialties. Comprehensive programs to address emotional well-being of physicians are important to promote collegiality and reduce symptoms of secondary traumatic stress. Safety and transparency with opportunities for group processing are identified as essentials for positive institutional culture, as well as peer support programs.

Complication rates of dilation and evacuation and labor induction in second-trimester abortion for fetal indications: A retrospective cohort study.

OBJECTIVE: To compare complication rates of dilation and evacuation (D&E) to mifepristone and misoprostol labor induction for second trimester abortion for fetal indications. STUDY DESIGN: We performed a retrospective cohort study comparing complication rates with D&E and labor induction abortion for fetal indications at 14 weeks 0 days through 23 weeks and 6 days gestation between January 1, 2009, and August 31, 2017. We extracted demographic, procedural, and outcome data, focusing specifically on complications of maternal hemorrhage, infection, emergency department visit, hospital readmission, retained tissue requiring dilation and curettage (D&C), manual placental removal, or thromboembolism. We compared complication rates between the D&E and induction groups using univariate and multivariate analyses. RESULTS: We included outcomes from 75 (48%) D&E and 81 (52%) labor induction abortions. We identified any complication in 1 (1%) and 7 (7%) of patients, respectively (p = 0.12). The only complication in the D&E group was hemorrhage with an estimated blood loss of 1000 mL not requiring transfusion. Labor induction complications included retained tissue requiring manual removal (n = 2) or D&C (n = 1) and hemorrhage (n = 2). CONCLUSION: There was no difference in complication rates between the D&E group and the labor induction group. IMPLICATIONS: This study compared outcomes between D&E and labor induction using mifepristone and misoprostol for second trimester abortion. Our complication rate for labor induction using mifepristone and misoprostol, and particularly our rate of retained placenta requiring D&C, was lower than what has been previously reported for second trimester labor induction termination using other methods. This study suggests there is a benefit for the routine use of mifepristone with misoprostol for second trimester labor induction. Additionally, the low rate of major complications in this study for both D&E and labor induction further validates the safety of both procedures for second trimester abortion.

An Analysis of Obstetrics-Gynecology Residency Interview Methods in a Single Institution.

OBJECTIVE: Interviews for residency are important for resident selection, yet how to best perform the interviews remains uncertain. Multiple approaches have been described with a variety of results. Our purpose of this study was to evaluate our Obstetrics-Gynecology residency program's interview structure to determine which interview components have association with performance evaluations completed by physicians and nurses during the residents' years of training at our program. DESIGN: Using only data from our matched residents, existing interview scores from our standard interview process were compared to performance evaluation scores completed by faculty and nursing throughout the training years. Our standard interview process consisted of 4 interviews with individual faculty, 1 structured behavioral-based interview by a blinded faculty member, and 1 interview with a pair of current residents. SETTING: A single, multisite, Obstetrics-Gynecology residency program. PARTICIPANTS: Interviewees of the Obstetrics-Gynecology residency program that ultimately matched with our program. RESULTS: Interview scores from 44 residents were compared to their performance evaluation scores. Positive associations were seen between performance evaluation scores and both resident teams' interviews and unstructured faculty interviews, with the resident teams' score showing a stronger degree of association. The behavioral-based interview total score did not have association with the performance evaluation scores, nor did any of the individual questions. CONCLUSIONS: Resident teams' interview scores of applicants show the strongest association with eventual performance evaluations completed by faculty and nursing during residency. This demonstrates that current residents should have a role in the resident selection process during interviews. This does not provide data to abandon behavior-based interview techniques, but rather encourage each program to carefully apply their use during the resident selection process.

No Room to "Lean In": A Qualitative Study on Gendered Barriers to Promotion and Leadership.

INTRODUCTION: The gender gap in professorship and leadership roles persists in academic medicine, whereas reasons for these disparities remain unclear. MATERIALS AND METHODS: Open-ended text responses to a 2013 faculty engagement survey were analyzed by using the grounded theory and consensual qualitative analysis techniques. The authors grouped 491 faculty's text responses into descriptive codes and three themes: (1) No Obstacles, (2) Barriers to Success, and (3) Concerns Regarding Processes. Demographics of codes were compared by using chi-square analysis. RESULTS: Male faculty identified barriers that included negative views of leadership or leaders. Female faculty, especially those in clinical roles, expressed barriers related to role overload, including that the demands of their current positions prevented advancement or addition of further roles, no matter how desirable further roles may be. Women also shared that considerable self-promotion was required to receive acknowledgement of their work and support by leadership. CONCLUSION: A proposed framework depicts male and female faculty's concerns on a continuum. No Obstacle and Process Concerns were relatively gender neutral, whereas large gender disparities occurred within the Barriers to Success theme. Women's barriers largely revolved around internal obstacles (I can't do any more), and men's barriers largely revolved around external factors (leaders are impeding my progress). Resources are needed to mitigate work overload specifically for female faculty, and to ensure that all faculty are both engaged in advanced career opportunities and encouraged to pursue leadership positions.

Safety of peripherally inserted central catheters during pregnancy: a retrospective study.

PURPOSE: We investigated the incidence of complications associated with peripherally inserted central line catheters, inserted using a standardized technique, during pregnancy and the postpartum period. MATERIALS AND METHODS: A retrospective case series was performed that included all pregnant and postpartum women who received peripherally inserted central catheters (PICCs) at a single institution between 2006 and 2014. Patient demographics and data on infectious, mechanical and thrombotic complications were collected. Some patients required more than one line insertion during the same pregnancy. In these instances, only the first line placement for each subject was included in the analysis of complications. RESULTS: One hundred and forty-six catheters were inserted in 112 pregnant and postpartum patients. The total incidence of complications was 17% (19/112). Specific complications included infection (n = 4, 3.6%), mechanical (n = 5, 4.4%), deep venous thrombosis (n = 2, 1.8%) and other (n = 8, 7.1%). Demographics of the complication and no complication groups were similar. CONCLUSIONS: In contrast with previous studies, we report a complication rate associated with peripheral line use in pregnant and postpartum women that appears similar to that in non-pregnant populations.