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      The National MD-PhD Program Outcomes Study: career paths followed by Black and Hispanic graduates

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      1 , 2 ,
      JCI Insight
      American Society for Clinical Investigation

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          Abstract

          Previous studies on attrition from MD-PhD programs have shown that students who self-identify as Black are more likely to withdraw before graduating than Hispanic students and students not from groups underrepresented in medicine (non-UIM). Here, we analyzed data collected for the National MD-PhD Program Outcomes Study, a national effort to track the careers of over 10,000 individuals who have graduated from MD-PhD programs over the past 60 years. On average, Black trainees took slightly longer to graduate, were less likely to choose careers in academia, and were more likely to enter nonacademic clinical practice; although, none of these differences were large. Black graduates were also more likely to choose careers in surgery or internal medicine, or entirely forego residency, and less likely to choose pediatrics, pathology, or neurology. Among those in academia, average research effort rates self-reported by Black, Hispanic, and non-UIM alumni were indistinguishable, as were rates of obtaining research grants and mentored training awards. However, the proportion of Black and Hispanic alumni who reported having NIH research grants was lower than that of non-UIM alumni, and the NIH career development to research project grant (K-to-R) conversion rate was lower for Black alumni. We propose that the reasons for these differences reflect experiences before, during, and after training and, therefore, conclude with action items that address each of these stages.

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          Race, ethnicity, and NIH research awards.

          We investigated the association between a U.S. National Institutes of Health (NIH) R01 applicant's self-identified race or ethnicity and the probability of receiving an award by using data from the NIH IMPAC II grant database, the Thomson Reuters Web of Science, and other sources. Although proposals with strong priority scores were equally likely to be funded regardless of race, we find that Asians are 4 percentage points and black or African-American applicants are 13 percentage points less likely to receive NIH investigator-initiated research funding compared with whites. After controlling for the applicant's educational background, country of origin, training, previous research awards, publication record, and employer characteristics, we find that black applicants remain 10 percentage points less likely than whites to be awarded NIH research funding. Our results suggest some leverage points for policy intervention.
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            Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties

            Objective To evaluate trends in racial, ethnic, and sex representation at US medical schools across 16 specialties: internal medicine, pediatrics, surgery, psychiatry, radiology, anesthesiology, obstetrics and gynecology, neurology, family practice, pathology, emergency medicine, orthopedic surgery, ophthalmology, otolaryngology, physical medicine and rehabilitation, and dermatology. Using a novel, Census-derived statistical measure of diversity, the S-score, we quantified the degree of underrepresentation for racial minority groups and female faculty by rank for assistant, associate, and full professors from 1990–2016. Methods This longitudinal study of faculty diversity uses data obtained from the American Association of Medical Colleges (AAMC) Faculty Roster from US allopathic medical schools. The proportion of professors of racial minority groups and female faculty by rank was compared to the US population based on data from the US Census Bureau. The Roster includes data on 52,939 clinical medical faculty in 1990, and 129,545 in 2016, at the assistant professor level or higher. The primary measure used in this study was the S-score, a measure of representation based on the probability of the observed frequency of faculty from a racial/ethnic group and sex, given the racial and ethnic distribution of the US. Pearson correlations and 95% confidence intervals for S-score with time were used to measure trends. Results Blacks and Hispanics showed statistically significant trends (p<0.05) towards increasing underrepresentation in most specialties and are more underrepresented in 2016 than in 1990 across all ranks and specialties analyzed, except for Black females in obstetrics & gynecology. White females were also underrepresented in many specialties and in a subset of specialties trended toward greater underrepresentation. Conclusions Current efforts to improve faculty diversity are inadequate in generating an academic physician workforce that represents the diversity of the US. More aggressive measures for faculty recruitment, retention, and promotion are necessary to reach equity in academia and healthcare.
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              Are MD-PhD programs meeting their goals? An analysis of career choices made by graduates of 24 MD-PhD programs.

              MD-PhD training programs provide an integrated approach for training physician-scientists. The goal of this study was to characterize the career path taken by MD-PhD program alumni during the past 40 years and identify trends that affect their success. In 2007-early 2008, 24 programs enrolling 43% of current trainees and representing half of the National Institutes of Health-funded MD-PhD training programs submitted anonymous data on 5,969 current and former trainees. The average program enrolled 90 trainees, required 8.0 years to complete, and had an attrition rate of 10%. Nearly all (95%) of those who graduated entered residencies. Most (81%) were employed in academia, research institutes, or industry; 16% were in private practice. Of those in academia, 82% were doing research and at least 61% had identifiable research funding. Whereas two-thirds devoted more than 50% effort to research, only 39% devoted more than 75% effort. Many with laboratory-based PhDs reported doing clinical, as well as basic and translational, research. Emerging trends include decreasing numbers of graduates who forego residencies or hold primary appointments in nonclinical departments, increasing time to graduation, and expanding residency choices that include disciplines historically associated with clinical practice rather than research. Most MD-PhD program graduates follow career paths generally consistent with their training as physician-scientists. However, the range of their professional options is broad. Further thought should be given to designing their training to anticipate their career choices and maximize their likelihood of success as investigators.
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                Author and article information

                Contributors
                Journal
                JCI Insight
                JCI Insight
                JCI Insight
                JCI Insight
                American Society for Clinical Investigation
                2379-3708
                8 May 2024
                8 May 2024
                8 May 2024
                : 9
                : 9
                : e178248
                Affiliations
                [1 ]Neuroscience and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
                [2 ]Medicine and Pharmacology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
                Author notes
                Address correspondence to: Myles H. Akabas, Professor of Neuroscience and Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA. Email: myles.akabas@ 123456einsteinmed.edu . Or to: Lawrence F. Brass, Professor of Medicine and Pharmacology, University of Pennsylvania Perelman School of Medicine, Room 815 BRB-II/II, 421 Curie Blvd, Philadelphia, Pennsylvania 19104, USA. Email: brass@ 123456Pennmedicine.upenn.edu .
                Author information
                http://orcid.org/0000-0001-8781-7846
                Article
                178248
                10.1172/jci.insight.178248
                11141911
                38716732
                5c003ce0-32e2-40b9-b11f-856ca4ba7d33
                © 2024 Akabas et al.

                This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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                Physician-Scientist Development

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