Bias, Black Lives, and Academic Medicine

Ansell, David; McDonald, Edwin K.

doi:10.1056/nejmp1500832

Cited by 68 publications

(45 citation statements)

References 3 publications

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“…Data from the Association of American Medical Colleges show that between 1980 and 2012, the number of black women graduates of US medical schools increased 4-fold while the number of black men graduating declined. 7 Most of the gains for underrepresented minorities in obstetrics and gynecology are likely among black women, partly owing to the high percentage of women entering the specialty.…”

Section: Ensuring a Diverse Physician Workforce: Progress But More Tomentioning

confidence: 99%

Diversity in Graduate Medical Education in the United States by Race, Ethnicity, and Sex, 2012

et al. 2015

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Section: Ensuring a Diverse Physician Workforce: Progress But More Tomentioning

confidence: 99%

Diversity in Graduate Medical Education in the United States by Race, Ethnicity, and Sex, 2012

et al. 2015

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“…These realities are not limited to health care, as evidenced by the recent #BlackLivesMatter campaign and protests at many U.S. medical schools. 10 A consistent subtext of disparities and injustice continually reinforces the dual obligations of race-conscious professionalism and, in doing so, shapes professional development. In this climate, African Americans often find themselves not only concerned with clinical excellence and professional advancement but also focused on how their career can most positively impact their community.…”

Section: Race-conscious Professionalism and Intrinsic Motivationmentioning

confidence: 99%

Race-Conscious Professionalism and African American Representation in Academic Medicine

et al. 2016

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African Americans remain substantially less likely than other physicians to hold academic appointments. The roots of these disparities stem from different extrinsic and intrinsic forces that guide career development. Efforts to ameliorate African American underrepresentation in academic medicine have traditionally focused on modifying structural and extrinsic barriers through undergraduate and graduate outreach, diversity and inclusion initiatives at medical schools, and faculty development programs. Although essential, these initiatives fail to confront the unique intrinsic forces that shape career development. America's ignoble history of violence, racism, and exclusion exposes African American physicians to distinct personal pressures and motivations that shape professional development and career goals. This article explores these intrinsic pressures with a focus on their historical roots; reviews evidence of their effect on physician development; and considers the implications of these trends for improving African American representation in academic medicine. The paradigm of "race-conscious professionalism" is used to understand the dual obligation encountered by many minority physicians not only to pursue excellence in their field but also to leverage their professional stature to improve the well-being of their communities. Intrinsic motivations introduced by race-conscious professionalism complicate efforts to increase the representation of minorities in academic medicine. For many African American physicians, a desire to have their work focused on the community will be at odds with traditional paths to professional advancement. Specific policy options are discussed that would leverage race-conscious professionalism as a draw to a career in academic medicine, rather than a force that diverts commitment elsewhere.

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“…(1) Investigators may view African American participants as sufficiently different from other participants that they impact the efficiency, outcomes, and validity of clinical trial enrollment. Such beliefs may be implicit in nature,(2) although this issue has not been specifically examined in the context of clinical trials. One example would be the belief that African American subjects are more likely to have cardiac disease, hypertension, and other comorbidities that may affect trial validity.…”

Section: Introductionmentioning

confidence: 99%

Challenging Assumptions About African American Participation in Alzheimer Disease Trials

Kennedy

Cutter

Wang

et al. 2017

The American Journal of Geriatric Psychiatry

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Objective We investigated potential effects of increased African American participation in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) clinical trials by examining differences in comorbid conditions and treatment outcome affecting trial design. Methods Using a meta-database of 18 studies from the Alzheimer’s Disease Cooperative Study and the Alzheimer’s Disease Neuroimaging Initiative, we included a cohort of 5,164 subjects for whom there were baseline demographic data and information on comorbid disorders, grouped by organ system. We used meta-analysis to compare prevalence of comorbidities, dropouts, and rates of change on the Alzheimer’s Disease Assessment Scale (ADAS-cog) by race. We also simulated clinical trial scenarios similar to recent therapeutic trials to determine effects of increased African American participation on statistical power. Results Approximately 7% of AD, 4% of MCI, and 11% of normal participants were African American. African American subjects had higher prevalence of cardiovascular disorders (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.71, 2.57) and higher rate of dropouts (OR 1.60, 95% CI 1.15, 2.21) compared to whites, but lower rates of other disorders. There were no significant differences in rate of progression (−0.862 points/year, 95% CI −1.89, 0.162) by race, and little effect on power in simulated trials with sample sizes similar to current AD trial designs. Conclusions Increasing African American participation in AD clinical trials will require adaptation of trial protocols to address comorbidities and dropouts. However, increased diversity is unlikely to negatively affect trial outcomes and should be encouraged to promote generalizability of trial results.

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Bias, Black Lives, and Academic Medicine

Cited by 68 publications

References 3 publications

Diversity in Graduate Medical Education in the United States by Race, Ethnicity, and Sex, 2012

Diversity in Graduate Medical Education in the United States by Race, Ethnicity, and Sex, 2012

Race-Conscious Professionalism and African American Representation in Academic Medicine

Challenging Assumptions About African American Participation in Alzheimer Disease Trials

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