Reaping what we sow: The emerging academic medicine workforce

Health Behavior and Outreach Core, Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 09/2008; 100(9):1026-34.
Source: PubMed


National efforts to increase diversity of academic medicine faculty led us to study the evolution of medical graduates' academic medicine career intentions. We conducted a retrospective cohort study of 1997-2004 U.S. allopathic medical graduates who completed both the Association of American Medical Colleges' Matriculating Student Questionnaire and Graduation Questionnaire, categorizing the evolution of academic medicine career intentions (sustained, emerging, diminished and no intent) by similarities/differences in graduates' responses to the career choice question on both questionnaires. Multivariable logistic regression models identified independent predictors of sustained and emerging intent (compared with no intent) and diminished intent (compared with sustained intent). Of 87,763 graduates, 67% indicated no intent, 20% emerging intent, 8% sustained intent and 5% diminished intent to pursue an academic medicine career. Asians were more likely and underrepresented minorities less likely to have sustained and emerging intent. Women were more likely to have emerging intent. Graduates planning more extensive career involvement in research at matriculation and reporting greater satisfaction with the quality of their medical education, higher clinical clerkship ratings, and lower debt were more likely to have sustained and emerging intent and less likely to have diminished intent. Graduates planning to practice in underserved areas and choosing family medicine were less likely to have sustained and emerging intent and more likely to have diminished intent (all p < 0.05). Findings can inform efforts to develop an academic medicine workforce that can meet our nation's healthcare needs and more equitably reflect the diversity of our society and medical student population.

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    • "The former finding differs from Jeffe et al. [20] who while comparing medical students' career interest as a first year and then as a fourth year found that compared to males, females gain interest in academia, whereas URM, in comparison to Whites, lose interest. [15] Similar to the findings reported by Jeffe et al., [20] URM students in this study believe that women and racial minorities have a harder time experiencing success in the academy. [3] This finding is not surprising given Froeschle and Sinkford's observation that academic dentistry is not particularly hospitable to female entrants. "
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    ABSTRACT: Purpose/Objectives: Female and under-represented racial and ethnic minority (URM) dental faculty are disproportionate to the gender, racial, and ethnic composition of the nation, despite trainees' and patients' preference for concordant faculty and providers. Although dental students represent a pipeline of potential faculty, little is known about their interest in academia. The purpose of this study was to determine if interest in academia, and facilitators and barriers in pursuing academia differed by gender, race, and ethnicity among a sample of dental students at one dental school located in the southeastern United States. Methods: A survey was sent to 334 dental students at a single dental school in the southeastern region of the United States. Overall there was a 54% response rate, totaling 180 students who participated in the study. Results: Gender and racial/ethnic background influence students' decisions to consider a career in academic dentistry, along with personal influence variables and beliefs about barriers to success in academic dentistry. Conclusion: Growing future faculty may depend on finding ways to match students with faculty mentors of same racial and ethnic backgrounds, increasing opportunities to explore career options during dental school via reduced required curriculum hours. This alternative would allow for more opportunities for URM to address access to care issues, as well as serve vulnerable and low income populations. Future studies should survey URM and female students within all US/Canadian dental schools when they are admitted, and again, just prior to matriculation, to determine if efforts to increase the academic pipeline are effective.
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    ABSTRACT: We tested the significance of associations among students' demographics, communication styles, and feedback received during clerkships. US medical students who completed at least one required clinical clerkship were invited between April and July 2006 to complete an anonymous, online survey inquiring about demographics, communication styles (assertiveness and reticence), feedback (positive and negative), and clerkship grades. The effects of self-identified race/ethnicity, gender, and generation (immigrant, first- or second-generation American) and their 2-way interactions on assertiveness, reticence, total positive and total negative feedback comments were tested using factorial analysis of covariance, controlling for age, clerkship grades, and mother's and father's education; pairwise comparisons used simple contrasts. Two-sided P values < .05 were considered significant. Medical students from 105 schools responded (N = 2395: 55% women; 57% white). Men reported more assertiveness than women (P = .001). Reticence (P < .001) and total positive comments (P = .006) differed by race/ethnicity; in pairwise contrasts, black, East Asian, and Native American/ Alaskan students reported greater reticence than white students (P < .001), and white students reported receiving more positive comments than black, and South and East Asian students. Race/ethnicity-by-generation (P = .022) and gender-by-generation (P = .025) interaction effects were observed for total negative comments; white first-generation Americans reported receiving the fewest and male immigrants reported receiving the most negative comments. Demographic differences in students' communication styles and feedback they received highlight a need for cultural competency training to improve medical student-teacher interactions, analogous to training currently advocated to improve physician-patient interactions.
    Journal of the National Medical Association 02/2009; 101(2):116-26. · 0.96 Impact Factor
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    ABSTRACT: The authors sought to identify variables independently associated with full-time faculty appointment among recent medical graduates. With institutional review board approval, the authors developed a database of individualized records for six midwestern medical schools' 1997-2002 graduates. Using multivariate logistic regression, they identified variables independently associated with full-time faculty appointment from among demographic, medical-school-related, and career-intention variables. They report adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Of 1,965 graduates in the sample, 263 (13.4%) held full-time faculty appointments in 2007-2008, including 14.4% (123/853) of women graduates and 8.6% (17/198) of underrepresented minority (URM) graduates. Women (OR: 1.386; 95% CI: 1.023-1.878), MD/PhD program graduates (OR: 2.331; 95% CI: 1.160-4.683), and graduates who reported a career-setting preference for "full-time university faculty" on the Association of American Medical Colleges' Graduation Questionnaire (OR: 3.164; 95% CI: 2.231-4.486) were more likely to have a full-time faculty appointment. Graduates who chose family medicine (OR: 0.433; 95% CI: 0.231-0.811) and surgical specialties (OR: 0.497; 95% CI: 0.249-0.994) were less likely to have a full-time faculty appointment. URM race/ethnicity was not independently associated with full-time faculty appointment (OR: 0.788; 95% CI: 0.452-1.375). Efforts to increase representation of women graduates in academic medicine seem to have met with greater success than efforts to increase representation of URM graduates. Greater participation of URM students in MD/PhD programs and in interventions during medical school that promote interest in academic medicine careers may increase URM graduates' representation in academic medicine.
    Academic medicine: journal of the Association of American Medical Colleges 07/2010; 85(7):1250-7. DOI:10.1097/ACM.0b013e3181e10159 · 2.93 Impact Factor
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