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Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations
The transition from medical school to residency is a critical step in the careers of physicians. Because of the standardized application process-wherein schools submit summative Medical Student Performance Evaluations (MSPE's)-it also represents a unique opportunity to assess the possible prevalence of racial and gender disparities, as shown elsewhere in medicine.
The authors conducted textual analysis of MSPE's from 6,000 US students applying to 16 residency programs at a single institution in 2014-15. They used custom software to extract demographic data and keyword frequency from each MSPE. The main outcome measure was the proportion of applicants described using 24 pre-determined words from four thematic categories (\"standout traits\", \"ability\", \"grindstone habits\", and \"compassion\").
The data showed significant differences based on race and gender. White applicants were more likely to be described using \"standout\" or \"ability\" keywords (including \"exceptional\", \"best\", and \"outstanding\") while Black applicants were more likely to be described as \"competent\". These differences remained significant after controlling for United States Medical Licensing Examination Step 1 scores. Female applicants were more frequently described as \"caring\", \"compassionate\", and \"empathic\" or \"empathetic\". Women were also more frequently described as \"bright\" and \"organized\".
While the MSPE is intended to reflect an objective, summative assessment of students' qualifications, these data demonstrate for the first time systematic differences in how candidates are described based on racial/ethnic and gender group membership. Recognizing possible implicit biases and their potential impact is important for faculty who strive to create a more egalitarian medical community.
Journal Article
Where Medical Statistics Meets Artificial Intelligence
Challenges at the interface of medical statistics and AI are population inference vs. prediction, generalizability, reproducibility and interpretation of evidence, and stability and statistical guarantees.
Journal Article
A practical approach to using statistics in health research : from planning to reporting
\"This book provides an outline with methodological steps of how to use statistics to analyze your research data. The book begins with a general introduction, which discusses what you should be trying to achieve with your statistical analysis. This involves describing the subjects you investigated and their outcomes, determining whether there is statistically significant evidence of differences in outcomes between groups of subjects, quantitatively describing effect sizes, and also determining whether any changes are large enough to be of clinical significance. Next, the authors cover data types and choosing statistical tests. This includes identifying the factor and outcome, and also identifying the type of data used to record the outcome. Readers are then introduced to multiple testing, the Chi-square test, and independent samples and the two-sample t-test. The Man-Whitney test is discussed, as well as the One-way ANOVA. Readers are taught how to Carrying out the Kruskal-Wallis test and the McNemar's test. The Paired t-test is covered, as well as how to carry out the Wilcoxon paired samples test. Readers are shown how to carry out the repeated measures ANOVA and the Friedman test. This includes discussion of merits of change in median, change in proportions in categories, and changes in high/low categories. The book concludes with a discussion on correlation and regression methods, and a detailed analysis on Cronbach's alpha\"-- Provided by publisher.
Book
Surgical time out: Our counts are still short on racial diversity in academic surgery
This study provides an updated description of diversity along the academic surgical pipeline to determine what progress has been made.
Data was extracted from a variety of publically available data sources to determine proportions of minorities in medical school, general surgery training, and academic surgery leadership.
In 2014–2015, Blacks represented 12.4% of the U.S. population, but only 5.7% graduating medical students, 6.2% general surgery trainees, 3.8% assistant professors, 2.5% associate professors and 2.0% full professors. From 2005-2015, representation among Black associate professors has gotten worse (−0.07%/year, p < 0.01). Similarly, in 2014–2015, Hispanics represented 17.4% of the U.S. population but only 4.5% graduating medical students, 8.5% general surgery trainees, 5.0% assistant professors, 5.0% associate professors and 4.0% full professors. There has been modest improvement in Hispanic representation among general surgery trainees (0.2%/year, p < 0.01), associate (0.12%/year, p < 0.01) and full professors (0.13%/year, p < 0.01).
Despite efforts to promote diversity in surgery, Blacks and Hispanics remain underrepresented. A multi-level national focus is imperative to elucidate effective mechanisms to make academic surgery more reflective of the US population.
Journal Article
Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review
BackgroundTo provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients’ well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance.ObjectiveThis review’s objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME).MethodsIn 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics.ResultsThe authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2).ConclusionsThe abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.
Journal Article
In sickness and in health : disease and disability in contemporary America
The increasing importance of sickness and disability data across health-related disciplines is the focus of this concise but comprehensive resource. It reviews the basics of morbidity at the population level by defining core concepts, analyzing why morbidity has overtaken mortality as central to demographic study, and surveying ways these data are generated, accessed, and measured.
Book
Gender and ethnic diversity in academic general surgery department leadership
Diversity in surgery has been shown to improve mentorship and patient care. Diversity has improved among general surgery (GS) trainees but is not the case for departmental leadership. We analyzed the race and gender distributions across leadership positions at academic GS programs.
Academic GS programs (n = 118) listed by the Fellowship and Residency Electronic Interactive Database Access system were included. Leadership positions were ascertained from department websites. Gender and race were determined through publicly provided data.
Ninety-two (79.3%) department chairs were white and 99 (85.3%) were men. Additionally, 88 (74.6%) program directors and 34 (77.3%) vice-chairs of education were men. A higher proportion of associate program directors were women (38.5%). Of 787 division-chiefs, 73.4% were white. Only trauma had >10% representation from minority surgeons. Women represented >10% of division chiefs in colorectal, thoracic, pediatric, and plastic/burn surgery.
Diversity among GS trainees is not yet reflected in departmental leadership. Effort is needed to improve disparities in representation across leadership roles.
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•Improvement in diversity is not reflected in departmental leadership.•More women serve as associate program directors than other leadership positions.•Only 4 specialties had >10% representation from women as division-chiefs.•Only trauma/ACS had >10% representation from minorities.•Highlights lack of diversity and need for increased representation in leadership.
Brief Summary: While general surgery trainees have become increasingly diverse, this improvement is not yet reflected in departmental leadership. Currently, more women serve as associate program directors than other leadership positions. However, only 4 specialties have >10% representation from women as division chiefs and only trauma/ACS had >10% representation from any underrepresented minorities. This highlights the lack of diversity and the need for increased representation in general surgery leadership.
Journal Article