TY - JOUR
T1 - Representation of American Indian and Alaska Native Individuals in Academic Medical Training
AU - Forrest, Lala L.
AU - Leitner, Brooks P.
AU - Vasquez Guzman, Cirila Estela
AU - Brodt, Erik
AU - Odonkor, Charles A.
N1 - Funding Information:
Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Forrest, Leitner, Odonkor. Administrative, technical, or material support: Forrest, Brodt, Odonkor. Supervision: Brodt, Odonkor. Conflict of Interest Disclosures: No disclosures were reported. Funding/Support: This work was supported by the Northwest Native American Center of Excellence at Oregon Health & Science University and its partners: The Northwest Portland Area Indian Health Board, University of California–Davis School of Medicine, and Washington State University Elson S. Floyd College of Medicine. This study was supported in part by the National Institutes of Health Medical Scientist Training Program grant T32GM007205 and by the Northwest Native American Center of Excellence, which was funded by the Health Resources and Services Administration, Bureau of Health Workforce under grant D34HP31026 and the Department of Health and Human Services under the grant D911IHS0009-01-00.
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/1/13
Y1 - 2022/1/13
N2 - Importance: Identifying gaps in inclusivity of Indigenous individuals is key to diversifying academic medical programs, increasing American Indian and Alaska Native representation, and improving disparate morbidity and mortality outcomes in American Indian and Alaska Native populations. Objective: To examine representation of American Indian and Alaska Native individuals at different stages in the 2018-2019 academic medical training continuum and trends (2011-2020) of American Indian and Alaska Native representation in residency specialties. Design, Setting, and Participants: A cross-sectional, population-based analysis was conducted using self-reported race and ethnicity data on trainees from the Association of American Medical Colleges (2018), the Accreditation Council for Graduate Medical Education (2011-2018), and the US Census (2018). Data were analyzed between February 18, 2020, and March 4, 2021. Exposures: Enrolled trainees at specific stages of medical training. Main Outcomes and Measures: The primary outcome was the odds of representation of American Indian and Alaska Native individuals at successive academic medical stages in 2018-2019 compared with White individuals. Secondary outcomes comprised specialty-specific proportions of American Indian and Alaska Native residents from 2011 to 2020 and medical specialty-specific proportions of American Indian and Alaska Native physicians in 2018. Fisher exact tests were performed to calculate the odds of American Indian and Alaska Native representation at successive stages of medical training. Simple linear regressions were performed to assess trends across residency specialties. Results: The study data contained a total of 238974607 White and American Indian and Alaska Native US citizens, 24795 US medical school applicants, 11242 US medical school acceptees, 10822 US medical school matriculants, 10917 US medical school graduates, 59635 residents, 518874 active physicians, and 113168 US medical school faculty. American Indian and Alaska Native individuals had a 63% lower odds of applying to medical school (odds ratio [OR], 0.37; 95% CI, 0.31-0.45) and 48% lower odds of holding a full-time faculty position (OR, 0.52; 95% CI, 0.44-0.62) compared with their White counterparts, yet had 54% higher odds of working in a residency specialty deemed as a priority by the Indian Health Service (OR, 1.54; 95% CI, 1.09-2.16). Of the 33 physician specialties analyzed, family medicine (0.55%) and pain medicine (0.46%) had more than an average proportion (0.41%) of American Indian and Alaska Native physicians compared with their representation across all specialties. Conclusions and Relevance: This cross-sectional study noted 2 distinct stages in medical training with significantly lower representation of American Indian and Alaska Native compared with White individuals. An actionable framework to guide academic medical institutions on their Indigenous diversification and inclusivity efforts is proposed.
AB - Importance: Identifying gaps in inclusivity of Indigenous individuals is key to diversifying academic medical programs, increasing American Indian and Alaska Native representation, and improving disparate morbidity and mortality outcomes in American Indian and Alaska Native populations. Objective: To examine representation of American Indian and Alaska Native individuals at different stages in the 2018-2019 academic medical training continuum and trends (2011-2020) of American Indian and Alaska Native representation in residency specialties. Design, Setting, and Participants: A cross-sectional, population-based analysis was conducted using self-reported race and ethnicity data on trainees from the Association of American Medical Colleges (2018), the Accreditation Council for Graduate Medical Education (2011-2018), and the US Census (2018). Data were analyzed between February 18, 2020, and March 4, 2021. Exposures: Enrolled trainees at specific stages of medical training. Main Outcomes and Measures: The primary outcome was the odds of representation of American Indian and Alaska Native individuals at successive academic medical stages in 2018-2019 compared with White individuals. Secondary outcomes comprised specialty-specific proportions of American Indian and Alaska Native residents from 2011 to 2020 and medical specialty-specific proportions of American Indian and Alaska Native physicians in 2018. Fisher exact tests were performed to calculate the odds of American Indian and Alaska Native representation at successive stages of medical training. Simple linear regressions were performed to assess trends across residency specialties. Results: The study data contained a total of 238974607 White and American Indian and Alaska Native US citizens, 24795 US medical school applicants, 11242 US medical school acceptees, 10822 US medical school matriculants, 10917 US medical school graduates, 59635 residents, 518874 active physicians, and 113168 US medical school faculty. American Indian and Alaska Native individuals had a 63% lower odds of applying to medical school (odds ratio [OR], 0.37; 95% CI, 0.31-0.45) and 48% lower odds of holding a full-time faculty position (OR, 0.52; 95% CI, 0.44-0.62) compared with their White counterparts, yet had 54% higher odds of working in a residency specialty deemed as a priority by the Indian Health Service (OR, 1.54; 95% CI, 1.09-2.16). Of the 33 physician specialties analyzed, family medicine (0.55%) and pain medicine (0.46%) had more than an average proportion (0.41%) of American Indian and Alaska Native physicians compared with their representation across all specialties. Conclusions and Relevance: This cross-sectional study noted 2 distinct stages in medical training with significantly lower representation of American Indian and Alaska Native compared with White individuals. An actionable framework to guide academic medical institutions on their Indigenous diversification and inclusivity efforts is proposed.
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U2 - 10.1001/jamanetworkopen.2021.43398
DO - 10.1001/jamanetworkopen.2021.43398
M3 - Article
C2 - 35024836
AN - SCOPUS:85123420705
VL - 5
JO - JAMA network open
JF - JAMA network open
SN - 2574-3805
IS - 1
M1 - 43398
ER -