Office of Diversity and Inclusion

The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

The present study presents preliminary evidence regarding the reliability and validity of the Multidimensional Inventory of Black Identity (MIBI). The MIBI consists of 7 subscales representing 3 stable dimensions of African American racial identity (Centrality, Ideology, and Regard). Responses to the MIBI were collected from 474 African American college students from a predominantly African American university (n = 185) and a predominantly White university (n = 289). As the result of factor analysis, a revised 51 -item scale was developed. Evidence was found for 6 subscales. The Public Regard subscale was dropped because of poor internal consistency. Interscale correlations suggest that the MIBI is internally valid. Relationships among the MIBF subscales and race-related behavior suggest that the instrument has external validity. Descriptive statistics for the revised MIBI are provided for the entire sample as well as by school. Racial identity is one of the most heavily researched aspects of African Americans' psychological lives. Racial identity has been associated with a number of phenomena including selfesteem (Hughes & Demo, 1989; Parham & Helms, 1985; Row

The purpose of this paper is to promote a broad and flexible perspective on ecological restoration of Southwestern (U.S.) ponderosa pine forests. Ponderosa pine forests in the region have been radically altered by Euro-American land uses, including livestock grazing, fire suppression, and logging. Dense thickets of young trees now abound, old-growth and biodiversity have declined, and human and ecological communities are increasingly vulnerable to destructive crown fires. A consensus has emerged that it is urgent to restore more natural conditions to these forests. Efforts to restore Southwestern forests will require extensive projects employing varying combinations of young-tree thinning and reintroduction of low-intensity fires. Treatments must be flexible enough to recognize and accommodate: high levels of natural heterogeneity; dynamic ecosystems; wildlife and other biodiversity considerations; scientific uncertainty; and the challenges of on-the-ground implementation. Ecological restoration should reset ecosystem trends toward an envelope of “natural variability,” including the reestablishment of natural processes. Reconstructed historic reference conditions are best used as general guides rather than rigid restoration prescriptions. In the long term, the best way to align forest conditions to track ongoing climate changes is to restore fire, which naturally correlates with current climate. Some stands need substantial structural manipulation (thinning) before fire can safely be reintroduced. In other areas, such as large wilderness and roadless areas, fire alone may suffice as the main tool of ecological restoration, recreating the natural interaction of structure and process. Impatience, overreaction to crown fire risks, extractive economics, or hubris could lead to widespread application of highly intrusive treatments that may further damage forest ecosystems. Investments in research and monitoring of restoration treatments are essential to refine restoration methods. We support the development and implementation of a diverse range of scientifically viable restoration approaches in these forests, suggest principles for ecologically sound restoration that immediately reduce crown fire risk and incrementally return natural variability and resilience to Southwestern forests, and present ecological perspectives on several forest restoration approaches.

This study examines the influence of perceived flexibility in the timing and location of work on work‐family balance. Data are from a 1996 International Business Machines (IBM) work and life issues survey in the United States ( n = 6,451 ). Results indicate that perceived job flexibility is related to improved work‐family balance after controlling for paid work hours, unpaid domestic labor hours, gender, marital status, and occupational level. Perceived job flexibility appears to be beneficial both to individuals and to businesses. Given the same workload, individuals with perceived job flexibility have more favorable work‐family balance. Likewise, employees with perceived job flexibility are able to work longer hours before workload negatively impacts their work‐family balance. Implications of these findings are presented.

A National Research Council report, Scientific Research in Education, has elicited considerable criticism from the education research community, but this criticism has not focused on a key assumption of the report—its Humean, regularity conception of causality. It is argued that this conception, which also underlies other arguments for “scientifically-based research,” is narrow and philosophically outdated, and leads to a misrepresentation of the nature and value of qualitative research for causal explanation. An alternative, realist approach to causality is presented that supports the scientific legitimacy of using qualitative research for causal investigation, reframes the arguments for experimental methods in educational research, and can support a more productive collaboration between qualitative and quantitative researchers.

Knowledge and motivational factors represent important but neglected topics in the study of recycling behavior. This article examines differences in knowledge, motives, and demographic characteristics of people who have the opportunity to recycle voluntarily. Information on these variables was obtained for 197 households in Illinois. The results indicated that recyclers in general were more aware of publicity about recycling and more knowledgeable about materials that were recyclable in the local area and the means for recycling these materials than were nonrecyclers. While both recyclers and nonrecyclers were motivated by concerns for the environment, non-recyclers were more concerned with financial incentives to recycle, rewards for recycling, and with matters of personal convenience. Few demographic characteristics distinguished recyclers from nonrecyclers.

Academic stress may be the single most dominant stress factor that affects the mental well-being of college students. Some groups of students may experience more stress than others, and the coronavirus disease 19 (COVID-19) pandemic could further complicate the stress response. We surveyed 843 college students and evaluated whether academic stress levels affected their mental health, and if so, whether there were specific vulnerable groups by gender, race/ethnicity, year of study, and reaction to the pandemic. Using a combination of scores from the Perception of Academic Stress Scale (PAS) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), we found a significant correlation between worse academic stress and poor mental well-being in all the students, who also reported an exacerbation of stress in response to the pandemic. In addition, SWEMWBS scores revealed the lowest mental health and highest academic stress in non-binary individuals, and the opposite trend was observed for both the measures in men. Furthermore, women and non-binary students reported higher academic stress than men, as indicated by PAS scores. The same pattern held as a reaction to COVID-19-related stress. PAS scores and responses to the pandemic varied by the year of study, but no obvious patterns emerged. These results indicate that academic stress in college is significantly correlated to psychological well-being in the students who responded to this survey. In addition, some groups of college students are more affected by stress than others, and additional resources and support should be provided to them.

Importance: It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE). Objective: To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism. Design, Setting, and Participants: This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018. Exposures: A panel of several established cardiovascular risk factors. Main Outcomes and Measures: Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25 131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI). Results: Of the 731 728 participants from the ERFC, 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421 537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers. Conclusions and Relevance: Older age, smoking, and adiposity were consistently associated with higher VTE risk.

The Multidimensional Model of Racial Identity was used to examine the relationship between racial identity and personal self-esteem (PSE) in a sample of African American college students (n = 173) and a sample of African American high school students (n = 72). Racial identity was assessed using the Centrality and Regard scales of the Multidimensional Inventory of Black Identity, whereas the Rosenberg Self-Esteem Scale was used to assess PSE. Four predictions were tested: (a) racial centrality is weakly but positively related to PSE; (b) private regard is moderately related to PSE; (c) public regard is unrelated to PSE; and (d) racial centrality moderates the relationship between private regard and PSE. Multiple regression analysis found that racial centrality and public racial regard were unrelated to PSE in both samples. Private regard was positively related to PSE in the college sample. Racial centrality moderated the relationship between private regard and PSE in both samples, such that the relationship was significant for those with high levels of centrality but nonsignificant for those with low levels.

Importance: With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines. Objective: To examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population. Design, Setting, and Participants: Repeated cross-sectional study of Association of American Medical Colleges data on self-reported race/ethnicity and sex of medical school applicants and matriculants compared with population distribution of the medical school-aged population (20-34 years). Data from US allopathic medical school applicants and matriculants from 2002 to 2017 were analyzed. Main Outcomes and Measures: Trends were measured using the representation quotient, the ratio of the proportion of a racial/ethnic group in the medical student body to the general age-matched US population. Linear regression estimates were used to evaluate the trend over time for Asian, black, white, Hispanic, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander medical school matriculants by sex. Results: The number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, -0.011; 95% CI, -0.015 to -0.007; P < .001). Conclusions and Relevance: Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

Diversity drives excellence. Diversity enhances innovation in biomedical sciences and, as it relates to novel findings and treatment of diverse populations, in the field of infectious diseases. There are many obstacles to achieving diversity in the biomedical workforce, which create challenges at the levels of recruitment, retention, education, and promotion of individuals. Here we present the challenges, opportunities, and suggestions for the field, institutions, and individuals to adopt in mitigating bias and achieving greater levels of equity, representation, and excellence in clinical practice and research. Our findings provide optimism for a bright future of fair and collaborative approaches that will enhance the power of our biomedical workforce.

PURPOSE: One challenge academic health centers face is to advance female faculty to leadership positions and retain them there in numbers equal to men, especially given the equal representation of women and men among graduates of medicine and biological sciences over the last 10 years. The purpose of this study is to investigate the explicit and implicit biases favoring men as leaders, among both men and women faculty, and to assess whether these attitudes change following an educational intervention. METHOD: The authors used a standardized, 20-minute educational intervention to educate faculty about implicit biases and strategies for overcoming them. Next, they assessed the effect of this intervention. From March 2012 through April 2013, 281 faculty members participated in the intervention across 13 of 18 clinical departments. RESULTS: The study assessed faculty members' perceptions of bias as well as their explicit and implicit attitudes toward gender and leadership. Results indicated that the intervention significantly changed all faculty members' perceptions of bias (P < .05 across all eight measures). Although, as expected, explicit biases did not change following the intervention, the intervention did have a small but significant positive effect on the implicit biases surrounding women and leadership of all participants regardless of age or gender (P = .008). CONCLUSIONS: These results suggest that providing education on bias and strategies for reducing it can serve as an important step toward reducing gender bias in academic medicine and, ultimately, promoting institutional change, specifically the promoting of women to higher ranks.

The study focuses on the relationship between racial identity and academic achievement for African American college students. The Multidimensional Model of Racial Identity (MMRI) was used to assess the relationship between racial centrality, racial ideology, and academic performance. A total of 248 participants were recruitedfrom a predominantly Black college and a predominantly White college and were administered the Multidimensional Inventory of Black Identity (MIBI) to assess their racial ideology and racial centrality. Participants also were asked to report their cumulative grade point averages (GPAs). Consistent with the MMRI, racial centrality moderates the relationship between racial ideology and academic performance such that assimilation and nationalist ideologies were negatively associated with GPA and a minority ideology was positively associated with GPA for students who scored high on racial centrality. Racial ideology was not a significant predictor of GPA for participants who scored low on racial centrality.

OBJECTIVE: To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses. DESIGN: Longitudinal survey. SETTING: 16 nationally representative US medical schools. PARTICIPANTS: 2884 students from class of 2003. MAIN OUTCOME MEASURES: Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients. RESULTS: 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor. CONCLUSION: Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.

This article reviews the individual and organizational implications of gig work using the emerging psychological contract between gig workers and employing organizations as a lens. We first examine extant definitions of gig work and provide a conceptually clear definition. We then outline why both organizations and individuals may prefer gig work, offer an in-depth analysis of the ways in which the traditional psychological contract has been altered for both organizations and gig workers, and detail the impact of that new contract on gig workers. Specifically, organizations deconstruct jobs into standardized tasks and gig workers adapt by engaging in job crafting and work identity management. Second, organizational recruitment of gig workers alters the level and type of commitment gig workers feel toward an employing organization. Third, organizations use a variety of nontraditional practices to manage gig workers (e.g., including by digital algorithms) and gig workers adapt by balancing autonomy and dependence. Fourth, compensation tends to be project-based and typically lacks benefits, causing gig workers to learn to be a "jack-of-all-trades" and learn to deal with pay volatility. Fifth, organizational training of gig workers is limited, and they adapt by engaging in self-development. Sixth, gig workers develop alternative professional and social relationships to work in blended teams assembled by organizations and/or adapt to social isolation. Challenges associated with these practices and possible solutions are discussed, and we develop propositions for testing in future research. Finally, we highlight specific areas for further exploration in future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Phenomenon: Performance during the clinical phase of medical school is associated with membership in the Alpha Omega Alpha Honor Medical Society, competitiveness for highly selective residency specialties, and career advancement. Although race/ethnicity has been found to be associated with clinical grades during medical school, it remains unclear whether other factors such as performance on standardized tests account for racial/ethnic differences in clinical grades. Identifying the root causes of grading disparities during the clinical phase of medical school is important because of its long-term impacts on the career advancement of students of color. Approach: To evaluate the association between race/ethnicity and clinical grading, we examined Medical Student Performance Evaluation (MSPE) summary words (Outstanding, Excellent, Very Good, Good) and 3rd-year clerkship grades among medical students at the University of Washington School of Medicine. The analysis included data from July 2010 to June 2015. Medical students were categorized as White, underrepresented minorities (URM), and non-URM minorities. Associations between MSPE summary words and clerkship grades with race/ethnicity were assessed using ordinal logistic regression models. Findings: Students who identified as White or female, students who were younger in age, and students with higher United States Medical Licensing Examination Step 1 scores or final clerkship written exam scores consistently received higher final clerkship grades. Non-URM minority students were more likely than White students (Adjusted Odds Ratio = 0.53), confidence interval [0.36, 0.76], p = .001, to receive a lower category MSPE summary word in analyses adjusting for student demographics (age, gender, maternal education), year, and United States Medical Licensing Examination Step 1 scores. Similarly, in four of six required clerkships, grading disparities (p < .05) were found to favor White students over either URM or non-URM minority students. In all analyses, after accounting for all available confounding variables, grading disparities favored White students. Insights: This single institution study is among the first to document racial/ethnic disparities in MSPE summary words and clerkship grades while accounting for clinical clerkship final written examinations. A national focus on grading disparities in medical school is needed to understand the scope of this problem and to identify causes and possible remedies.

BACKGROUND: Deep learning algorithms derived in homogeneous populations may be poorly generalizable and have the potential to reflect, perpetuate, and even exacerbate racial/ethnic disparities in health and health care. In this study, we aimed to (1) assess whether the performance of a deep learning algorithm designed to detect low left ventricular ejection fraction using the 12-lead ECG varies by race/ethnicity and to (2) determine whether its performance is determined by the derivation population or by racial variation in the ECG. METHODS: We performed a retrospective cohort analysis that included 97 829 patients with paired ECGs and echocardiograms. We tested the model performance by race/ethnicity for convolutional neural network designed to identify patients with a left ventricular ejection fraction ≤35% from the 12-lead ECG. RESULTS: The convolutional neural network that was previously derived in a homogeneous population (derivation cohort, n=44 959; 96.2% non-Hispanic white) demonstrated consistent performance to detect low left ventricular ejection fraction across a range of racial/ethnic subgroups in a separate testing cohort (n=52 870): non-Hispanic white (n=44 524; area under the curve [AUC], 0.931), Asian (n=557; AUC, 0.961), black/African American (n=651; AUC, 0.937), Hispanic/Latino (n=331; AUC, 0.937), and American Indian/Native Alaskan (n=223; AUC, 0.938). In secondary analyses, a separate neural network was able to discern racial subgroup category (black/African American [AUC, 0.84], and white, non-Hispanic [AUC, 0.76] in a 5-class classifier), and a network trained only in non-Hispanic whites from the original derivation cohort performed similarly well across a range of racial/ethnic subgroups in the testing cohort with an AUC of at least 0.930 in all racial/ethnic subgroups. CONCLUSIONS: Our study demonstrates that while ECG characteristics vary by race, this did not impact the ability of a convolutional neural network to predict low left ventricular ejection fraction from the ECG. We recommend reporting of performance among diverse ethnic, racial, age, and sex groups for all new artificial intelligence tools to ensure responsible use of artificial intelligence in medicine.

BACKGROUND: Genotyping-by-sequencing (GBS) is a high-throughput genotyping approach that is starting to be used in several crop species, including bread wheat. Anchoring GBS tags on chromosomes is an important step towards utilizing them for wheat genetic improvement. Here we use genetic linkage mapping to construct a consensus map containing 28644 GBS markers. RESULTS: Three RIL populations, PBW343 × Kingbird, PBW343 × Kenya Swara and PBW343 × Muu, which share a common parent, were used to minimize the impact of potential structural genomic variation on consensus-map quality. The consensus map comprised 3757 unique positions, and the average marker distance was 0.88 cM, obtained by calculating the average distance between two adjacent unique positions. Significant variation of segregation distortion was observed across the three populations. The consensus map was validated by comparing positions of known rust resistance genes, and comparing them to wheat reference genome sequences recently published by the International Wheat Genome Sequencing Consortium, Rye and Ae. tauschii genomes. Three well-characterized rust resistance genes (Sr58/Lr46/Yr29, Sr2/Yr30/Lr27, and Sr57/Lr34/Yr18) and 15 published QTLs for wheat rusts were validated with high resolution. Fifty-two per cent of GBS tags on the consensus map were successfully aligned through BLAST to the right chromosomes on the wheat reference genome sequence. CONCLUSION: The consensus map should provide a useful basis for analyzing genome-wide variation of complex traits. The identified genes can then be explored as genetic markers to be used in genomic applications in wheat breeding.

Recent events in the United States have catalyzed the need for all educators to begin paying attention to and discovering ways to dialogue about race. No longer can health professions (HP) educators ignore or avoid these difficult conversations. HP students are now demanding them. Cultural sensitivity and unconscious bias training are not enough. Good will and good intentions are not enough. Current faculty development paradigms are no longer sufficient to meet the educational challenges of delving into issues of race, power, privilege, identity, and social justice.Engaging in such conversations, however, can be overwhelmingly stressful for untrained faculty. The authors argue that before any curriculum on race and racism can be developed for HP students, and before faculty members can begin facilitating conversations about race and racism, faculty must receive proper training through intense and introspective faculty development. Training should cover how best to engage in, sustain, and deepen interracial dialogue on difficult topics such as race and racism within academic health centers (AHCs). If such faculty development training-in how to conduct interracial dialogues on race, racism, oppression, and the invisibility of privilege-is made standard at all AHCs, HP educators might be poised to actualize the real benefits of open dialogue and change.

PURPOSE: To describe how racial microaggressions may affect optimal learning for under-represented health professions students. METHOD: The authors conducted focus groups and individual interviews from November 2017 to June 2018 with 37 students at University of California, Davis and Yale University who self-identified as underrepresented in medicine or nursing. Questions explored incidence, response to, and effects of racial microaggressions, as well as students' suggestions for change. Data were organized and coded, then thematic analysis was used to identify themes and subthemes. RESULTS: The data showed consistent examples of microaggressions across both health professions and schools, with peers, faculty, preceptors, and structural elements of the curricula all contributing to microaggressive behavior. The 3 major themes were: students felt devalued by microaggressions; students identified how microaggressions affected their learning, academic performance, and personal wellness; and students had suggestions for promoting inclusion. CONCLUSIONS: The data indicated that students perceived that their daily experiences were affected by racial microaggressions. Participants reported strong emotions while experiencing racial microaggressions including feeling stressed, frustrated, and angered by these interactions. Further, students believed microaggressions negatively affected their learning, academic performance, and overall well-being. This study shows the need for leadership and faculty of health professions schools to implement policies, practices, and instructional strategies that support and leverage diversity so that innovative problem-solving can emerge to better serve underserved communities and reduce health disparities.