Reaping what we sow: the emerging academic medicine workforce
ABSTRACT 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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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. · 0.91 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 · 3.47 Impact Factor
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ABSTRACT: Many education research questions cannot be answered using participants from one institution or short periods of follow-up. In response to societal demands for accountability and evidence of effectiveness, new models of research must be developed to study the outcomes of educational activities. Following the 2007 Millennium Conference on Medical Education Research, organizers assigned a task force to explore the use of longitudinal databases in education research. This article summarizes the task force's findings. Similar to the Framingham studies in clinical medicine, longitudinal databases assemble prospectively collected information to retrospectively answer questions of interest. Many studies using such databases have been published. The task force identified three general approaches to database-type research. First, institutions can obtain identified information from existing sources, link it with school-specific information and other identified information, deidentify it, and merge it with similar information from other collaborating schools. Second, researchers can obtain from existing sources deidentified information on large samples and explore associations within this dataset. Third, investigators can design and implement databases to prospectively collect trainee information over time and across multiple institutions for the purpose of education research. Although costly, such comprehensive, purpose-built databases would ensure the availability of information needed to answer a variety of medical education research questions. Millennium Conference participants believed that stakeholders should explore the funding and development of such prospective databases. In the meantime, education researchers should use existing sources of individualized learner data to better understand how to develop competent, compassionate clinicians.Academic medicine: journal of the Association of American Medical Colleges 08/2010; 85(8):1340-6. DOI:10.1097/ACM.0b013e3181e5c050 · 3.47 Impact Factor