Association of Sex, Race, Ethnicity, and Income With Sustained and Cultivated Interest in Internal Medicine.

Abstract

There is a lack of diversity in the Internal Medicine (IM) workforce with respect to race, ethnicity, sex, and socioeconomic background. Evaluating sociodemographic predictors and student interest in IM residency may provide insights for support at the medical school level to promote diverse interest in IM. To examine associations between student ethnoracial identity, sex, and socioeconomic background with IM interest from matriculation to graduation. Retrospective cohort study. US MD matriculants from 2014-2015 and 2015-2016 cohorts. A sustained interest was defined as IM interest at matriculation and subsequent IM residency placement. A cultivated interest was defined as initial non-IM interest and placement into IM residency. Poisson regressions estimated associations between ethnoracial identity, sex, and family income with sustained or cultivated interest in IM, adjusting for IM clerkship satisfaction, USMLE Step 1 and Step 2 score. Among 18,765 matriculants, 51.7% identified as female, 61.5% as White, and 24.3% as low-income. IM clerkship satisfaction was associated with IM residency placement (p < 0.001). Among students initially interested in IM, females (aRR 0.87, 95% CI [0.80-0.94]) were less likely to sustain interest. Among initially uninterested students, Asian (aRR 1.65, 95% CI [1.54-1.76]), Hispanic (aRR 1.31, 95% CI [1.16-1.48]), and Black (aRR 1.22, 95% CI [1.07-1.39]) students were more likely to report cultivated interest compared to White students, while females were less likely compared to male students (aRR 0.77, 95% CI [0.72-0.82]). Disparities in IM workforce diversity may originate in medical school, where female students were less likely to sustain IM interest, while Asian, Black, and Hispanic students were more likely to develop interest. Such results necessitate targeted support by medical schools and graduate medical education programs.