A. Teherani is professor, Department of Medicine, education researcher, Center for Faculty Educators, and director of program evaluation, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-9832. K.E. Hauer is professor, Department of Medicine, and associate dean for assessment, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045. A. Fernandez is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. T.E. King Jr is professor, Department of Medicine, and dean, University of California, San Francisco, School of Medicine, San Francisco, California. C. Lucey is professor of medicine and vice dean for education, University of California, San Francisco, School of Medicine, San Francisco, California.
Acad Med. 2018 Sep;93(9):1286-1292. doi: 10.1097/ACM.0000000000002323.
While students entering medical schools are becoming more diverse, trainees in residency programs in competitive specialties and academic medicine faculty have not increased in diversity. As part of an educational continuous quality improvement process at the University of California, San Francisco, School of Medicine, the authors examined data for the classes of 2013-2016 to determine whether differences existed between underrepresented in medicine (UIM) and not-UIM students' clinical performance (clerkship director ratings and number of clerkship honors grades awarded) and honor society membership-all of which influence residency selection and academic career choices.This analysis demonstrated differences that consistently favored not-UIM students. Whereas the size and magnitude of differences in clerkship director ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership.The authors use these findings to illustrate the amplification cascade, a phenomenon in which small differences in assessed performance lead to larger differences in grades and selection for awards. The amplification cascade raises concerns about opportunities for UIM students to compete successfully for competitive residency programs and potentially enter academic careers. Using a fishbone diagram, a continuous quality improvement root cause analysis tool, the authors contextualize their institutional results. They describe potential causes of group differences, drawing from the education disparities literature, and propose interventions and future research. They also share countermeasures adopted at their institution and encourage other medical schools to consider similar exploration of their institutional data.
虽然进入医学院的学生越来越多样化，但在竞争激烈的专业住院医师培训计划和学术医学教师中，多样性并没有增加。作为加利福尼亚大学旧金山分校医学院教育持续质量改进过程的一部分，作者检查了 2013 年至 2016 年的班级数据，以确定医学中代表性不足的学生（UIM）和非 UIM 学生的临床表现（科室主任评分和授予的科室荣誉成绩数量）和荣誉社团成员身份之间是否存在差异-所有这些都影响住院医师选择和学术职业选择。这项分析表明，非 UIM 学生具有一致的优势。虽然科室主任评分差异的大小很小，但 UIM 学生获得的荣誉成绩大约只有非 UIM 学生的一半，被选为荣誉社团成员的可能性也低了三倍。作者利用这些发现来说明放大级联现象，即在评估表现中的微小差异导致成绩和获得奖励的差异更大。放大级联现象引起了人们对 UIM 学生成功竞争竞争激烈的住院医师培训计划并有可能进入学术职业的机会的关注。作者使用鱼骨图，一种持续质量改进的根本原因分析工具，将他们的机构结果置于上下文中。他们从教育差距文献中汲取灵感，描述了群体差异的潜在原因，并提出了干预措施和未来的研究。他们还分享了他们所在机构采取的对策，并鼓励其他医学院校考虑对其机构数据进行类似的探索。
