Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
St Joseph's Medical Center, Stockton, California.
JAMA Netw Open. 2024 Sep 3;7(9):e2432679. doi: 10.1001/jamanetworkopen.2024.32679.
Physicians who belong to minoritized racial and ethnic groups remain underrepresented and underpromoted. Serving as a chief resident is an important position of leadership and prestige, and indicates a benchmark for future professional success. However, it is unknown if disparities in race and/or sex exist in the chief resident selection process.
To describe race, ethnicity, and sex of emergency medicine (EM) chief residents and determine the association of racial identity and the intersectionality of race and sex for selecting chief residents in US emergency medicine departments.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data collected from the Association of American Medical Colleges and the Electronic Residency Application Service in the graduating classes of 2017 and 2018. Data were analyzed between December 2021 and January 2023.
Relative risk (RR) of selection for chief residency for Black, Asian, and Hispanic EM residents in comparison with White counterparts.
Among 3408 studied residents, 738 (21.7%) served as chief resident (2253 male [66.1%]; 451 Asian [13.2%], 144 Black [4.2%], 158 Hispanic [4.6%], 239 more than 1 race [7.0%], 46 other [1.3%], and 2370 White [69.5%]). Of chiefs, 81 (11.0%) identified as Asian, 17 (2.3%) as Black, and 26 (3.5%) Hispanic. Asian residents were 78% (95% CI, 63%-96%) as likely to be promoted to chief resident compared with White peers, and Black residents were 51% (95% CI, 32%-80%) as likely as White residents. In our fully adjusted model, racial differences remained significant for Black residents, who were half as likely as white residents to be selected for chief residency (adjusted risk ratio [aRR], 0.55; 95% CI, 0.36-0.82). Overall, White women were most likely to be selected for chief residency and 20% more likely to be selected than White men counterparts (aRR, 1.20; 95% CI, 1.03-1.39). In comparison, women underrepresented in medicine (a category that included residents identified as Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander) were least likely to be selected for chief promotion, and 50% as likely to be selected for chief resident compared with White men (aRR, 0.50; 95% CI, 0.06-0.66).
In this 2024 nationally representative study of EM residents, chief promotion was lower among residents identifying as Asian or Black, and in particular, women underrepresented in medicine. This study's findings suggest further review of chief resident selection process by residency programs and accreditation bodies is needed to ensure workforce equity for promotion and opportunities for leadership.
属于少数族裔的医生在数量上仍然不足，晋升机会也较少。担任首席住院医师是一个重要的领导和声望职位，表明未来职业成功的基准。然而，目前尚不清楚在选择急诊医学部门的首席住院医师过程中是否存在种族和/或性别的差异。
描述急诊医学（EM）首席住院医师的种族、民族和性别，并确定种族认同的交叉性以及种族和性别的交叉性对选择美国急诊医学部门首席住院医师的影响。
设计、地点和参与者：本队列研究分析了 2017 年和 2018 年毕业班级中美国医学协会和电子住院医师申请服务收集的数据。数据于 2021 年 12 月至 2023 年 1 月进行分析。
与白人同行相比，黑人、亚洲和西班牙裔 EM 住院医师担任首席住院医师的相对风险 (RR)。
在 3408 名研究住院医师中，有 738 人担任首席住院医师（2253 名男性 [66.1%]；451 名亚洲人 [13.2%]、144 名黑人 [4.2%]、158 名西班牙裔 [4.6%]、239 名以上种族 [7.0%]、46 名其他种族 [1.3%]和 2370 名白人 [69.5%]）。首席中有 81 人（11.0%）认定为亚洲人，17 人（2.3%）为黑人，26 人（3.5%）为西班牙裔。与白人同龄人相比，亚洲住院医师晋升为首席住院医师的可能性为 78%（95%CI，63%-96%），而黑人住院医师的可能性为 51%（95%CI，32%-80%）。在我们完全调整的模型中，黑人居民的种族差异仍然显著，他们担任首席住院医师的可能性是白人居民的一半（调整风险比 [aRR]，0.55；95%CI，0.36-0.82）。总体而言，白人女性最有可能被选为首席住院医师，比白人男性同行高 20%（aRR，1.20；95%CI，1.03-1.39）。相比之下，在医学领域代表性不足的女性（包括被认定为黑人、西班牙裔、美国印第安人或阿拉斯加原住民和夏威夷原住民或其他太平洋岛民的居民）被选为首席晋升的可能性最低，与白人男性相比，被选为首席住院医师的可能性低 50%（aRR，0.50；95%CI，0.06-0.66）。
在这项针对 2024 年全国代表性的急诊医学住院医师的研究中，亚洲或黑人身份的住院医师晋升机会较低，尤其是在医学领域代表性不足的女性。这项研究的结果表明，需要进一步审查住院医师计划和认证机构的首席住院医师选择过程，以确保晋升机会和领导机会的劳动力公平。
