Adverse Childhood Experiences, Household Income, and Mentorship Among Interns Who Are Underrepresented in Medicine

Abstract

Background Underrepresented in medicine (UIM) interns have unique lived experiences that affect their paths to medicine, and more information is needed for medical residency and fellowship programs to better support them. Objective We describe self-reported differences between UIM and White physician interns in key demographic areas, including household income growing up, physician mentorship, and adverse childhood experiences (ACEs). Methods Between 2019 and 2021, we administered a diversity survey to incoming medical interns at the University of Minnesota-Twin Cities. Response rates across the 3 years were 51.2% (167 of 326), 93.9% (310 of 330), and 98.9% (354 of 358), respectively. We conducted analyses to compare UIM and White groups across demographic variables of interest. Results A total of 831 of 1014 interns (81.9%) completed the survey. Relative to White interns, UIM interns had lower household incomes growing up, lower rates of mentorship, and higher rates of experiencing 4 or more ACEs. The odds of experiencing the cumulative burden of having a childhood household income of $29,999 or less, no physician mentor, and 4 or more ACEs was approximately 10 times higher among UIM (6.41%) than White (0.66%) interns (OR=10.38, 95% CI 1.97-54.55). Conclusions Childhood household income, prior mentorship experiences, and number of ACEs differed between UIM and White interns.

The Matthew Effect: Prevalence of Doctor and Physician Parents among Ophthalmology Applicants

“…25 The intersection of race, ethnicity, and socioeconomic status in medical matriculation is well established, with URiM applicants and trainees more likely to have lower childhood household incomes and fewer options for financial support. 7 Specific to the financing of resident education, the application and interview process alone is expensive, 26 and 60% of residents are rent-burdened, as defined as 30% or more of first year gross monthly salary captured by the mean local monthly rent index. Rent-burdened institutions are also less likely to offer housing-related benefits.…”

“…One study of interns at a single academic center found all interns, whether white or Under-Represented in Medicine (URiM), grew up in households on average more affluent than the general population. 7 To better evaluate the Matthew effect, and by proxy the role of childhood household income, in the matriculation to residency, this study was designed to determine the proportion of applicants to a single ophthalmology residency program over a 5-year period that explicitly and voluntarily indicated they had a physician or doctor as a parent.…”