In 2021, an ad hoc committee of the United States (U.S.) National Academies of Science, Engineering, and Medicine (NASEM) affirmed that robust, relationship-centered primary care is the foundation of efficient, effective health care. Yet the ad hoc committee also noted primary care was “slowly dying,” due to chronic under-investment, ill-suited payment models, and inadequate workforce planning and development. Encouragingly, efforts to revitalize primary care are underway. To accelerate this movement by generating expert consensus recommendations on the highest priority actions to take in repairing the frayed U.S. primary care base, clinical scientists at the University of California Davis (UCD) School of Medicine convened the Summit to Revitalize Primary Care (Rev PC). Summit recommendations were generated in four closed working sessions of a national Expert Committee. Committee members were selected to ensure a breadth of perspectives (e.g., health plans, purchasers of insurance, regulatory agencies, health systems, clinicians, educators, researchers, economists) from the public and private sectors. Seven high priority recommendations emerged: (1) Increase the proportion of spending on primary care, coupled with initiatives to slow the growth in total health care spending; (2) Pay for primary care using models that support high quality, team-based, relationship-centered, equitable care; (3) Assist practices in transformation to advanced primary care models and assess the impacts on clinical teams, patients, and communities; (4) Maximize primary care’s potential to equitably advance health; (5) Advocate for training an appropriately large and diverse primary care physician workforce; (6) Expand research to address the most pressing issues in primary care; (7) Collaborate with a broad array of societal stakeholders in messaging the importance of robust primary care. These recommendations both overlap with and expand on those of the NASEM ad hoc committee and subsequent Standing Committee on Primary Care. Broad pursuit of the recommendations would catalyze sustained momentum toward appropriate primary care investment and workforce planning and development, enabling U.S. primary care to realize its yet-unfulfilled potential to improve population health and advance health equity while helping to control growth in total health care costs.

Importance: Increasing underrepresented in medicine (URIM) physicians among historically underserved communities helps reduce health disparities. The concordance of URIM physicians with their communities improves access to care, particularly for American Indian and Alaska Native, Black, and Hispanic or Latinx individuals. Objectives: To explore county-level racial and ethnic representation of US internal medicine (IM) residents, examine racial and ethnic concordance between residents and their communities, and assess whether representation varies by presence of academic institutions or underserved settings. Design, setting, and participants: This retrospective cross-sectional study collected data from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education (ACGME), Area Health Resources Files, and US Department of Education data on ACGME-accredited US IM residency programs and their associated county populations. Self-reported racial and ethnic data from 2018 for 4848 residents in 393 IM programs in 205 counties were used. Data were analyzed between February 15 and September 20, 2024. Exposure: County-level presence for academic health centers (AHCs), minority-serving institutions (MSIs), health professional shortage areas (HPSAs), and rurality. Main outcomes and measures: Main outcomes were representation quotients (RQs) or the ratio of the proportion of IM residents and their concordant county-level racial and ethnic populations. Quantile linear regression models on median representation were used to identify the association with URIM, Asian, and White residents by US Census division and county-level AHCs, MSIs, HPSAs, and rurality. Results: Among 4848 residents, 4 (0.08%) self-identified as American Indian or Alaskan Native, 1709 (35.3%) as Asian, 289 (6.0%) as Black, 211 (4.4%) as Hispanic or Latinx, 2 (0.04%) as Native Hawaiian or Other Pacific Islander, and 2633 (54.3%) as White. A total of 761 (15.7%) were classified as URIM. Among URIM groups, American Indian and Alaska Native (mean [SE] RQ, 0.00 [0.04]), Black (mean [SE] RQ, 0.09 [0.20]), Hispanic and Latinx (mean [SE] RQ, 0.00 [0.04]), and Native Hawaiian and other Pacific Islander (mean [SE] RQ, 0.00 [0.26]) residents were grossly underrepresented compared with their training sites' county-level representation. Fifty-one of 205 counties (24.8%) with IM programs had no URIM residents. Black and Hispanic or Latinx residents had higher representation in counties with more MSIs (mean [SD] RQ, 0.19 [0.24]; P = .04; mean [SD] RQ, 0.15 [0.04]; P < .001, respectively), and Hispanic or Latinx residents were less represented in counties with more AHCs (mean [SD] RQ, 0.00 [0.06]; P < .001). Asian residents had lower RQs in counties with more MSIs (mean [SD] RQ, 6.00 [0.65]; P < .001), and White residents had higher representation in counties with greater presence of AHCs (mean [SD] RQ, 0.77 [0.04]; P = .007). Conclusions and relevance: In this cross-sectional study, URIM IM residents remained underrepresented compared with their program's county populations. These findings should inform racial and ethnic diversity policies to address the continuing underrepresentation among graduate medical education physicians, which adversely impacts the care of historically underserved communities.

Importance:The 2023 Supreme Court of the United States (SCOTUS) Students for Fair Admissions, Inc. v President and Fellows of Harvard College ruling to restrict race-based affirmative action is a landmark decision with potentially far-reaching consequences. Objective:To examine application, acceptance, and matriculation rates into doctor of medicine (MD)-granting programs before and after the 2023 SCOTUS decision. Design, Setting, and Participants:This retrospective cross-sectional study used deidentified data from the Association of American Medical Colleges on applicants and matriculants to US MD-granting medical schools 5 years before (2019-2023) and 1 year after (2024) the SCOTUS ruling. Main Outcomes and Measures:Application, acceptance, and matriculation into MD-granting programs. Results:The study sample included 291 764 applicants to MD programs between 2019 and 2024 (162 211 identifying as female [55.59%]; 4576 American Indian, Alaska Native, Native Hawaiian, or Pacific Islander [1.57%], 84 122 Asian [28.83%], 34 256 Black [11.74%], 35 707 Hispanic [12.24%], and 154 621 White [53.00%]). Compared with mean acceptance rates in 2019 to 2023, acceptance rates in 2024 were higher for White (40.37% vs 47.47%; difference, 7.10 percentage points [95% CI, 6.21 to 7.98 percentage points]; P < .001) and Asian (38.26% vs 45.19%; difference, 6.93 percentage points [95% CI, 5.78 to 8.07 percentage points]; P < .001) applicants and lower for Black applicants (36.06% vs 33.08%; difference, -2.98 percentage points [95% CI, -4.74 to -1.21 percentage points]; P < .001) and underrepresented in medicine (URiM) applicants overall (39.68% vs 38.33%; difference, -1.35 percentage points [95% CI, -2.60 to -0.09 percentage points]; P = .02). No racial or ethnic difference in acceptance rates were observed in 2019 to 2023, but in 2024, URiM applicants had significantly lower acceptance rates than White (difference, -9.14 percentage points; P < .001) and Asian (difference, -6.86 percentage points; P < .001) applicants. Comparing the mean of 18 304 matriculants in 2019 to 2023 with 19 018 matriculants in 2024, White student representation decreased from 10 132 matriculants (55.35%) to 10 158 matriculants (53.41%) for a decrease of 1.94 percentage points (95% CI, -3.31 to -0.56 percentage points; P = .009), Asian student representation increased from 5102 matriculants (27.87%) to 6288 matriculants (33.06%) for an increase of by 5.19 percentages points (95% CI, 3.49 to 6.88 percentage points; P < .001), and URiM student representation decreased from 4466 matriculants (24.39%) to 3963 matriculants (20.83%) for a decrease of 3.56 percentage points (95% CI, -5.34 to -1.77 percentage points; P < .001), equating to 503 fewer URiM matriculants in 2024. Post-SCOTUS decision declines in URiM representation were concentrated in schools located in states without prior state-level affirmative action bans (mean [SD] change, -6.14 [8.93] percentage points vs 0.10 [8.11] percentage points; P < .001). Conclusions and Relevance:In this study, URiM student matriculation into US medical schools declined after the 2023 SCOTUS ruling, with an emergent disparity in acceptance rates of URiM applicants relative to Asian and White students. The decline in URiM student matriculation was concentrated in states without a preexisting state-level affirmative action ban, suggesting that there may be an association between the SCOTUS ruling and demographic changes in matriculation.

PROBLEM:Our nation faces an urgent need for more primary care (PC) physicians, yet interest in PC careers is dwindling. Students from underrepresented in medicine (UIM) backgrounds are more likely to choose PC and practice in underserved areas yet their representation has declined. Accelerated PC programs have the potential to address workforce needs, lower educational debt, and diversify the physician workforce to advance health equity. APPROACH:With support from Kaiser Permanente Northern California (KPNC) and the American Medical Association's Accelerating Change in Medical Education initiative, University of California School of Medicine (UC Davis) implemented the Accelerated Competency-based Education in Primary Care (ACE-PC) program - a six-year pathway from medical school to residency for students committed to health equity and careers in family medicine or PC-internal medicine. ACE-PC accepts 6-10 students per year using the same holistic admissions process as the 4-year MD program with an additional panel interview that includes affiliated residency program faculty from UC Davis and KPNC. The undergraduate curriculum features: PC continuity clinic with a single preceptor throughout medical school; a 9-month longitudinal integrated clerkship; supportive PC faculty and culture; markedly reduced student debt with full-tuition scholarships; weekly PC didactics; and clinical rotations in affiliated residency programs with the opportunity to match into specific ACE-PC residency tracks. OUTCOMES:Since 2014, 70 students have matriculated to ACE-PC, 71% from UIM groups, 64% are first-generation college students. Of the graduates, 48% have entered residency in family medicine and 52% in PC-internal medicine. In 2020, the first graduates entered the PC workforce; all are practicing in California, including 66% at federally qualified health centers, key providers of underserved care.

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Training programs in pulmonary and critical care medicine have greatly expanded in the past decade, yet they do not reflect the racial/ethnic and economic diversity of the United States, which has significant implications for health equity. The lack of representation across medical education is likely to worsen with the recent Supreme Court decision banning affirmative action. The authors review health disparities in pulmonary and critical care medicine, the relationship of the workforce to health equity, and 10 tactics for addressing this urgent public health issue.

This article describes the "The Admissions Revolution: Bold Strategies for Diversifying the Healthcare Workforce" conference, which preceded the 2022 Beyond Flexner Alliance Conference and called for health professions institutions to boldly reimagine the admission process to diversify the health care workforce. Proposed strategies encompassed 4 key themes: admission metrics, aligning admission practices with institutional mission, community partnerships to fulfill social mission, and student support and retention. Transformation of the health professions admission process requires broad institutional and individual effort. Careful consideration and implementation of these practices will help institutions achieve greater workforce diversity and catalyze progress toward health equity.

This Viewpoint discusses what higher education institutions can learn from UC Davis when it comes to ensuring equity for their students now that the US Supreme Court has eliminated race-conscious college admissions.

Importance:Despite decades-long calls for increasing racial and ethnic diversity, the medical profession continues to exclude members of Black or African American, Hispanic or Latinx, and Indigenous groups.Objective:To describe US medical school admissions leaders' experiences with barriers to and advances in diversity, equity, and inclusion.Design, Setting, and Participants:This qualitative study involved key-informant interviews of 39 deans and directors of admission from 37 US allopathic medical schools across the range of student body racial and ethnic composition. Interviews were conducted in person and online from October 16, 2019, to March 27, 2020, and analyzed from October 2019 to March 2021.Main Outcomes and Measures:Participant experiences with barriers to and advances in diversity, equity, and inclusion.Results:Among 39 participants from 37 medical schools, admissions experience ranged from 1 to 40 years. Overall, 56.4% of participants identified as women, 10.3% as Asian American, 25.6% as Black or African American, 5.1% as Hispanic or Latinx, and 61.5% as White (participants could report >1 race and/or ethnicity). Participants characterized diversity broadly, with limited attention to racial injustice. Barriers to advancing racial and ethnic diversity included lack of leadership commitment; pressure from faculty and administrators to overemphasize academic scores and school rankings; and political and social influences, such as donors and alumni. Accreditation requirements, holistic review initiatives, and local policy motivated reforms but may also have inadvertently lowered expectations and accountability. Strategies to overcome challenges included narrative change and revision of school leadership structure, admissions goals, practices, and committee membership.Conclusions and Relevance:In this qualitative study, admissions leaders characterized the ways in which entrenched beliefs, practices, and power structures in medical schools may perpetuate institutional racism, with far-reaching implications for health equity. Participants offered insights on how to remove inequitable structures and implement process changes. Without such action, calls for racial justice will likely remain performative, and racism across health care institutions will continue.

Purpose To conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs). Method From June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care. Results A total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08). Conclusions Structural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.

Academic Medicine, Vol. 96, No. 11S / November 2021 Supplement S209 3 Nembhard IM, Edmondson AC. Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. J Organ Behav. 2006;27:941–966. 4 Tsuei SH, Lee D, Ho C, Regehr G, Nimmon L. Exploring the construct of psychological safety in medical education. Acad Med. 2019;94(suppl 11):S28–S35. 5 Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD. The prevalence of medical student mistreatment and its association with burnout. Acad Med. 2014;89:749–754.

This cohort study examines the association between Medical College Admission Test (MCAT) scores, disability status and category, and performance on US Medical Licensing Examination (USMLE) Step 1 and Step 2 CK scores.

Health care workforce diversity is a critical determinant of health equity and the social mission of medical education. Medical schools have a social contract with the public, which provides significant financial support to academic medical centers. Although a focus on diversity is critical in the admissions process for health professions schools, most US medical schools have failed to achieve racial-ethnic or economic diversity representative of the general US population. This article discusses limitations of holistic admissions, structural challenges for diverse learners in medical education, and how to implement socially accountable admissions.

Studies employing data collected over 15 years ago suggested salutary effects of postbaccalaureate (PB) premedical coursework on medical school class diversity, academic performance, and primary care training. The studies may have limited current applicability given changes in medical school admissions paradigms and population demographics. Using data from interviewees at >1 of 5 California public medical schools between 2011-2013 (N=3805), we examined associations of PB premedical coursework with underrepresented race/ethnicity; academic performance (United States Medical Licensing Examination Step 1 and Step 2 scores, clerkship Honors); and primary care residency. Adjusting for age, sex, and year, PB coursework was associated with underrepresented race/ethnicity, but not after further adjustment for self-designated disadvantage (SDA). PB coursework was not associated with academic performance or primary care residency. Holistic consideration of SDA and UIM status in admissions coupled with robust matriculant support may merit exploration as an alternative to PB coursework for increasing medical school diversity.

In this narrative medicine essay a father recalls the traumatic death of his healthy young son and the steps he and his family took to overcome their guilt, repair their relationships, and honor the boy’s life.

NOTE: The first page of text has been automatically extracted and included below in lieu of an abstract Developing a Multidisciplinary Engineering Program at Arizona State University’s East Campus Chell Roberts, Darryl Morrell, Robert Grondin, Chen-Yaun Kuo, Robert Hinks, Scott Danielson: College of Technology and Applied Science Mark Henderson: Ira A. Fulton School of Engineering Arizona State University Abstract The purpose of this paper is to present some key elements of the design process used to create a new multidisciplinary undergraduate engineering program and document the emerging program model. The program will be housed in the newly created Department of Engineering at Arizona State University’s East Campus and will award a BSE in Engineering degree; the program will seek accreditation under the ABET general engineering criteria. The new engineering program is being developed from a clean slate by a founding team that will begin implementation with its inaugural freshman class in Fall Semester of 2005. Elements of the design process discussed include: a preliminary planning process that focused on data gathering and feasibility assessment; the design process for student and program objectives and outcomes; the development of brand identity; design of a curricular structure; design of required engineering competencies that form a common foundation experience; and the design process for identifying program concentrations. Some observations and next steps are also presented. Introduction In July of 2003, a feasibility assessment and preliminary planning process was initiated for creation of an engineering program at ASU East Campus. This process resulted in a plan to develop a new engineering program at ASU’s East Campus. The need for this program is driven by the rapid population growth of the Phoenix metropolitan area, capacity restrictions at ASU’s Tempe campus and at other state universities, forecasts of engineering student and industry demand, and a desire to develop a polytechnic campus at ASU. Unlike many curriculum development or reform efforts, the development of this new program began with a blank slate. This has given the founding faculty team unprecedented freedom and flexibility in the design of this program, resulting in the development of a novel and flexible curriculum that we believe will address the needs of engineering graduates in the modern, global workplace. In this paper, we provide some background, and then describe several of the processes used to develop the program and its curriculum. In particular, we present the planning process leading to Proceedings of the 2005 American Society for Engineering Education Annual Conference & Exposition Copyright © 2005, American Society for Engineering Education

As medical schools seek to address the growing disparity between the socioeconomic makeup of their students and the general population, it is important to understand the academic trajectory of disadvantaged students. We used a locally-developed multicomponent socioeconomic disadvantage (SED) measure and the self-designated disadvantaged (SDA) question ["yes" (+) or "no" (-)] from the American Medical College Application Service application to examine academic performance of students from three disadvantaged categories (high SED/SDA+, high SED/SDA-, and low SED/SDA+); with low SED/SDA-as the reference group across five California schools. Compared with reference, the DA+ subgroups scored lower on USMLE Step 1 and Step 2 Clinical Knowledge examinations and received fewer clerkship Honors. After adjustment for academic metrics and sociodemographic variables, high SED subgroups performed similarly to reference, but performance gaps for low SED/SDA+ students persisted. Medical schools must better understand the institutional and other drivers of academic success in disadvantaged students.