New Healthcare Disparities Grant Draws Attention to Retention Issues Among Underrepresented Groups of Medical Trainees

Taj Mustapha, ’09, ’10, MD, assistant professor in the Departments of Medicine and Pediatrics at the University of Minnesota Medical School, is studying how unfairness manifests during medical training, where it is prevalent and who is most affected. Her work, supported by the Medical School's Rapid Response Grant to Reduce Racial/Ethnic Disparities in Healthcare, will build a tool to better measure how fairness impacts learners from typically underrepresented backgrounds.

AAMC data demonstrates that women and racial/ethnic minorities are less likely to pursue an academic career than their white and male counterparts, even when they choose an academic training program, such as the U of M Medical School. 

“Something is happening during residency, during that training time in academic programs, that’s turning groups away. My hypothesis is that, similar to other professions — where we see that lack of fairness affects everyone to some degree, but particularly affects marginalized people — if we make it more fair in general, then everyone will be positively impacted and the between-group differences could be diminished,” said Dr. Mustapha, who completed an internal medicine residency in 2009 and a pediatric residency in 2010 — both at the Medical School — where she served as the chief resident in her pediatric residency at the time.

Industrial and organizational psychologists have been thinking about workplace fairness for a long time. There are three key concepts to understand. First, distributive equity. For example, are people compensated similarly for the same kind of work. Second, procedural equity. If someone completes a task, will the company give them the same response as another individual and does the response differentiate depending on who someone is? Third, interpersonal equity. Are social relationships formed equally and given the same respect? If everyone on a team is supposed to meet with their manager for 45 minutes, does everyone get the same amount of time? Or, if some people are invited to a golf outing, then why aren’t some others?

“We’ve never looked at it in academic medicine, and we haven’t figured out yet in what ways we’re not fair and in what ways are we driving people away. We’re losing people who are specifically underrepresented in academics,” Dr. Mustapha said.

Because of the regulatory environment associated with residency, there are some inherent instances of fairness in the system. For example, all first-year residents get paid the same regardless of specialty. But, issues arise when looking at turnover. Dr. Mustapha says there are glaring demographic discrepancies between groups of people who remain interested in academic medicine over time. Personal growth and changes of preference will always account for part of that difference in how many people choose a certain path, but Dr. Mustapha said this should be a consistent figure across all demographics, and she wants to understand why it’s not. 

Unfortunately, there isn’t a tool in place for researchers to elucidate these discrepancies. This is also compounded by the trainee’s work environment. Medical trainees are in unique work environments dissimilar to many of the workplace dynamics previously studied in organizational psychology. Trainees have a different boss every week, if not every day, and they are constantly working with new nurses and peers within their program. Work teams in academic medicine are fluid by design. Therefore, existing organizational justice instruments cannot adequately capture perceptions of organizational justice in medicine. 

“It’s really hard to judge fairness in conjunction with the dynamism of teams, so we have to create a brand new tool. Our ultimate goal would be to measure fairness and slice it multiple ways, not only by demographics but also by training year and institution. But, we don’t even have a tool yet, so our whole project is about creating a measurement instrument to even measure this since we don’t have one now,” Dr. Mustapha said.

Developing the tool is a process that aims to target key issues for those who are likely to lose interest in academic medicine.

“The first phase was finding what matters and what doesn’t to residents. Now, we’re giving it back to a purposefully-sampled, diverse group of residents, and then that’ll help us whittle it down from over 70 questions to a more manageable list,” Dr. Mustapha said.

She hopes this work will allow future researchers to dive into which aspects of the training environment contribute to workplace attrition for medical trainees to help inform future education standards and best practices. 

“I’m hoping we create something good enough to be used on a national level. Then, the goal of course is that if you find unfairness, you do something about it. It’s not just to measure it but to actually get granular information so you can affect it and make it more fair,” Dr. Mustapha said.