Mediators of Racial/Ethnic Disparities in Mentored K Award Receipt Among U.S. Medical School Graduates

Abstract

Purpose Mentored K (K01/K08/K23) career development awards are positively associated with physicians’ success as independent investigators; however, individuals in some racial/ethnic groups are less likely than others to receive this federal funding. The authors sought to identify variables that can explain (mediate) the association between race/ethnicity and mentored K award receipt among U.S. LCME-accredited medical school graduates who planned research-related careers. Method The authors analyzed de-identified data from the Association of American Medical Colleges and from the National Institutes of Health Information for Management, Planning, Analysis, and Coordination II grants database for a national cohort of 28,690 graduates from 1997–2004 who planned research-related careers, followed through August 2014. The authors examined ten potential mediators (four research activities, two academic-performance measures, medical-school research intensity, degree program, debt, and specialty) of the association between race/ethnicity and mentored K award receipt in models comparing underrepresented minorities in medicine (URM) and non-URM graduates. Results Among 27,521 graduates with complete data (95.9% of study-eligible graduates), 1,147 (4.2 %) received mentored K awards, including 79 of 3,341 URM (2.4%) and 1,068 of 24,180 non-URM (4.4%) graduates. Nine variables (all but debt) were significant mediators and together they explained 96.2% (95% confidence interval, 79.1%–100%) of the association between race/ethnicity and mentored K award receipt. Conclusions Research-related activities during and after medical school and standardized academic measures largely explained the association between race/ethnicity and mentored K award receipt in this national cohort. Interventions targeting these mediators could mitigate racial/ethnic disparities in the federally funded physician-scientist research workforce.

Prevalence and Predictors of Us Medical Graduates’ Federal F32, Mentored-K, and R01 Awards: A National Cohort Study

“…(31) Using mediation analysis,(34) Step 1 scores alone explained 80% of the effect of race/ethnicity on K-award receipt among medical-school graduates planning research-related careers. (35) Thus, racial/ethnic differences in medical-school academic performance may contribute to persistent racial/ethnic disparities in physicians’ participation in the federally funded biomedical-research workforce at multiple stages of their post-graduation professional development.…”

Inclusion in the Pulmonary, Critical Care, and Sleep Medicine Physician-Scientist Workforce. Building with Intention

“…Research experience, paper authorship, and F32 awards are predictors of successful mentored K award applications, and this association is particularly strong for UIM groups ( 37 ). However, high-quality mentorship for developing physician-scientists who will persist beyond the early stages in academia is of vital importance.…”

Strategies to Enhance Diversity, Equity, and Inclusion in Pathology Training Programs: A Comprehensive Review of the Literature

“…Several studies have revealed disparities in US medical student performances on the USMLE, with UIM students disproportionately scoring lower on USMLE step 1 and step 2 exams when compared with students who do not identify as UIM 4,5,9,11,12 (Table 2). Similar disparities in examination performance exist for the Medical College Admission Test.…”

“…Nonpathology studies have suggested that using objective academic metrics in isolation (ie, United States Medical Licensing Examination [USMLE] step 1 and step 2 scores, medical school clerkship grades and evaluations, Alpha Omega Alpha Honor Medical Society [AOA] status, and research experiences) as initial residency interview screening tools may disproportionately screen out UIM applicants. [5][6][7][8][9][10][11][12][13] Other studies have shown that implicit biases may have a negative impact on residency applicant selection. [14][15][16][17][18][19][20] Nonetheless, the benefits of diversity in training programs are well described in the literature and include protection against depression for interns from both UIM and non-UIM groups and promotion of a more diverse training experience.…”