Jung G Kim¹
Christy Boscardin², Eric Holmboe³, Karen Hauer², Kenji Yamazaki⁴, Isabel Chen⁵ and Dowin Boatright¹
1 NYU Grossman School of Medicine
2 UCSF
3 Accreditation Council for Graduate Medical Education
4 Kaiser Permanente Bernard J Tyson School of Medicine

Studies have examined competency rating differences associated with residents’ race/ethnicity and gender, with assessments of professionalism particularly prone to bias.1-3 Program-related factors including racial representation of faculty and the community training site may influence professionalism ratings but are relatively unknown. 

Racial factors with the ACGME professionalism competency for U.S. residents in ACGME- accredited internal medicine programs were examined. ACGME Milestones data were linked with the AAMC and U.S. Area Health Resource File demographic datasets, with two dichotomous graduation outcomes: significantly low and exceedingly high scores. Logistic regression analyses on 14,288 residents graduated in 2017 and 2018 were examined for differences by underrepresented in medicine (URiM) residents, faculty URiM representation, and % non-White residents at the county-level. 

URiM residents had similar mean {SD} scores (7.3 {.84}) with non-URiM (7.4 {.86}). For every quartile increase of URiM program faculty, the odds of having significantly lower scores for all residents increased 30.2 {7.3–125.7; p<.001} and 6.4 (1.4-29.6; p=.02). Increasing odds for exceedingly high scores were found for every quartile increase of URiM faculty: 1.3 (CI=1.2–1.4; p<.001) and 1.5 (CI=1.4–1.6; p<.001). Programs with mostly URiM faculty (46.7%) had residents with lower odds (0.8; CI 0.7–0.8; p<.001} of receiving exceedingly high scores. For every quartile increase of non-White county residents, the odds of having significantly lower scores increased 5.0 {2.3–11.0; p<.001}. 

Racial characteristics for faculty and county-level populations across U.S.-accredited internal medicine residencies predicted differing professionalism assessment graduation scores for all residents versus URiM resident status alone, which did not indicate greater odds of receiving significantly low or exceedingly high scores. 

Further study is needed on program environmental factors that may influence the assessment of residents of core physician competencies such as professionalism during training. 

Trainees may be subjected to differing graduating competency-based ratings based on demographic factors within and outside of residency program settings. 

References (maximum three) 

1. Edgar L, Roberts S, Holmboe E. Milestones 2.0: A Step Forward. J Grad Med Educ. 2018;10(3):367-369. doi:10.4300/JGME-D-18-00372.1 

2. Boatright D, Anderson N, Kim JG, et al. Racial and Ethnic Differences in Internal Medicine Residency Assessments. JAMA Netw Open. 2022;5(12):e2247649. doi:10.1001/jamanetworkopen.2022.47649 

3. Hauer KE, Jurich D, Vandergrift J, et al. Gender Differences in Milestone Ratings and Medical Knowledge Examination Scores Among Internal Medicine Residents. Academic Medicine. 2021;96(6):876-884. doi:10.1097/ACM.0000000000004040