Underrepresented Minorities and Academic Difficulty During Family Medicine Residency: No Association?

The brief report “Common Factors Among Family Medicine Residents Who Encounter Difficulty”1 published in the April 2018 issue of Family Medicine examined various elements felt to make an impact on family medicine residents’ success. The authors showed the association of academic challenges with being older and the interesting observation that, in their population, those residents who transferred into family medicine from other programs were significantly less likely to encounter difficulty. We found this information immediately relevant and applaud the work of the authors in this area.

Our roles as residency faculty have required us to participate in the remediation of residents in difficulties ranging from academic challenges to unprofessionalism. We’ve found it imperative to know the factors that increase the likelihood that a resident experiences challenges during his or her training. Knowledge of these factors brings greater clarity during recruitment and aids us as we set our residents up for future success.

We were surprised that the authors did not comment on the race or ethnicity of the residents studied—their sample of residents was large enough to capture some underrepresented minority (URM: black, Latino, and Native American) residents. Other authors have associated minority status with an increased likelihood of being placed on academic probation in residency2 even though this finding was not specific to family medicine residencies. It is also noted that URM faculty encounter increased responsibility for the same reward, promotion bias, and frank racism in their careers.3,4 Extrapolating from this research done on faculty, could it be that URM residents are similarly exposed to bias, racism, and discrimination? Could this affect how they are evaluated in residency?

Even though this is the suggestion, we believe that URM residents in family medicine are of equal competence to their counterparts and should not be significantly more likely than any other residents to encounter difficulty in residency. The authors of this study may have missed an opportunity to determine if, in their sample, there was any association between URM status and difficulty in residency.

If the authors’ data shows no significant disparity in the rate of academic difficulty among URM residents, it would be a finding that highlights the strength of residency training in our specialty. Such a finding would create a positive association for URM family medicine residents. This is not often found in the literature.

Family medicine welcomes and embraces URM faculty and residents; our specialty prides itself on its diversity. We need every resident to graduate with the skills necessary for independent practice as we attempt to alleviate the extreme and worsening primary care shortage in diverse communities across the country. Now that the authors have identified factors shared by residents in difficulty, we can use this information to prepare even at-risk residents for success in our discipline.