Background: In our previous work we found being female or Underrepresented in Medicine (URiM) is correlated with a lower career interest in emergency medicine (CIEM) even after controlling for academic ability, student indebtedness, and common career values identified to correlate with CIEM. Identifying whether medical students’ (MS) from these groups have baseline differences in CIEM or if this difference develops during medical training is critically important for the specialty. Our hypothesis is that students from both groups have similar CIEM to their peers at medical school entry, but that their CIEM is lower by the time of residency application.
Methods: Secondary data analyses were performed on a cross-section of all MS who applied to the Electronic Residency Application Service (ERAS) from 2005-2010. Separate binary logistic regression models (BLM) were fitted with the outcomes being entering interest in emergency medicine, planned application into emergency medicine (EM), and continued practice in EM. Each of the BLMs included several groups of independent variables: Demographics, Student Attitudes, Debt, GPA, Standardized Tests, and when appropriate Medical School Experiences. Comparisons were then made between MS based on gender and URiM status across educational phases.
Results: MS from URiM backgrounds had a significantly lower CIEM at medical school interest and residency application (OR 0.63 95% 0.56-0.72 and OR 0.69 95% CI 0.56-0.84, respectively). Female and male MS had a statistically similar (but female trend toward lower) CIEM on medical school entry (OR 0.97 95% CI 0.89-1.05). At residency application CIEM for female students was significantly lower than males (OR 0.72 95% CI 0.63-0.81). After residency application, both female (OR0.98 95%CI 0.69-1.39) and URiM students (OR 1.01 95% CI 0.58-1.78) had similar persistence in an EM career as any other emergency medicine residents.
Conclusion: While URiM students have persistently lower CIEM, female students CIEM decreases during medical school. Despite the differences in baseline, CIEM of all MS who enter EM persist to practice at the same level. The timing of lowered CIEM in both groups may allow for targeted intervention to improve representation in the specialty.