Project Summary
Health disparities persist in the U.S. with underserved populations suffering lower quality of care and worse
outcomes. National leaders in medicine have called for widespread efforts to recruit and train
underrepresented minorities in medicine (URM) to supply the physician workforce and who can serve
underserved communities. Although the recruitment of URM medical students is increasing, their retention in
the physician profession is less certain. For URM resident physicians, Graduate Medical Education (GME)
learning environment factors that perpetuate biases due to race/ethnicity and gender have high potential to
hinder their professional development and retention in medicine. These include required assessments on
residents subjected to assessment bias within their training programs. Little is known nationally about the GME
learning environment factors associated with URM physician assessment bias, particularly in their key
formative years as residents and prior to becoming fully licensed physicians. Our overarching goal is to
investigate the GME learning environment factors impacting the assessment of resident physicians training in
primary care. The primary objective is to identify and test modifiable factors among URM resident physicians
training in all family medicine and internal medicine GME programs using an integrated, multilevel dataset
sourced from national bodies. Our hypotheses center on a multilevel conceptual model and preliminary data
that includes the representation of URM and gender in the GME learning environment, and how program-
related factors may impact the assessments of residents. Using multiple logistic regression and multi-level
growth curve modeling, we will examine the degree to which URM representation, gender, and program factors
are associated with assessment bias, and how these factors may impact the trajectory of measurements of
resident learning in Accreditation Council of GME (ACGME) physician competencies for all U.S. residents
training in accredited family medicine and internal medicine programs. The specific aims for this study are 1)
examine whether assessment inequities for URM and women residents in the ACGME Milestone assessments
are associated with representation of URM and women faculty, and 2) examine how measurements of learning
trajectories for URM and women residents in the ACGME Milestone assessment ratings are associated with
program factors. We have assembled a team of experts in medical education assessment, workforce diversity,
medical education policy, and analytics, and expect our outcomes to inform national leaders in medical
education and primary care physician workforce planning to better support URM physicians training in GME.
This study also meets current demands to investigate the structural barriers that limit primary care physician
workforce diversity and will align with the NIH Health Disparities Strategic Plan’s commitment to improving
minority health and address their disparities.
