Key Points Question How does representation of American Indian and Alaska Native individuals at specific stages of academic medical training compare with representation of their White counterparts? Findings This cross-sectional study including 1.35 million American Indian and Alaska Native and White individuals in each stage of the 2018-2019 academic medical training continuum found that, compared with their White peers, American Indian and Alaska Native individuals had 63% lower odds of applying to medical school compared with the general US population and 48% lower odds of holding a full-time faculty position postresidency. Meaning These findings suggest there are distinct stages in academic medical training for targeted policy and program changes to increase the representation of American Indian and Alaska Native individuals.

Trainees’ value as effective leaders within academic medicine has been increasingly recognized. From their perspective as adult learners who enter medical education from diverse backgrounds, trainees offer significant value to the teaching, learning, and practice of medicine. As such, trainees have developed and led various successful initiatives throughout academic medicine. In this Invited Commentary, 2 medical students with national leadership roles provide their perspectives on how student-led initiatives and advocacy can help push academic medicine forward. The authors first provide an overview of the success of student-led initiatives throughout medical education as evidenced by the Trainee-Authored Letters to the Editor in this issue, highlighting the unique contributions and perspectives of trainees in the development and implementation of new initiatives or ways of thinking. Although trainees add value to many areas in academic medicine, here the authors highlight 4 current areas that align with Association of American Medical Colleges priorities: (1) public health emergencies including the COVID-19 pandemic; (2) equity, inclusion, and diversity; (3) wellness and resilience amongst trainees and health care providers; and (4) recent changes to the United States Medical Licensing Examination and the transition to residency. By sharing their experiences with student-led initiatives within each of these domains, the authors provide lessons learned and discuss successes and obstacles encountered along the way. Overall, there is a critical need for increased engagement of trainees in medical education. Empowering trainees now ensures the academic medicine leaders of tomorrow are prepared to face the challenges that await them.

Purpose: Growth hormone (GH) replacement decreases insulin sensitivity in healthy individuals. However, the effects of GH on organ-specific insulin sensitivity and glucose effectiveness are not well characterized. The purpose of this study was to evaluate the effects of GH administration for 26 weeks on muscle and hepatic insulin sensitivity and glucose effectiveness in healthy older individuals. Methods: This report is from a 26-week randomized, double-blind, placebo-controlled parallelgroup trial in healthy, ambulatory, community-dwelling older women and men. We compared surrogate indices of insulin sensitivity [The quantitative insulin-sensitivity check index (QUICKI), muscle insulin sensitivity index (MISI), hepatic insulin resistance index (HIRI)] and glucose effectiveness [oral glucose effectiveness index (oGE)] derived from oral glucose tolerance tests (OGTTs) in subjects before and after 26 weeks of administration of GH (n=17) or placebo (n=15) as an exploratory outcome. Results: GH administration for 26 weeks significantly increased fasting insulin concentrations and HIRI but did not significantly change MISI or oGE when compared to the placebo group. Conclusions: GH administration for 26 weeks in healthy older subjects impairs insulin sensitivity in the liver but not skeletal muscle and does not alter glucose effectiveness.