Mediators of Racial/Ethnic Disparities in Mentored K Award Receipt Among U.S. Medical School Graduates

Abstract

Purpose: Mentored K (K01/K08/K23) career development awards are positively associated with physicians' success as independent investigators; however, individuals in some racial/ethnic groups are less likely to receive this federal funding. The authors sought to identify variables that explain (mediate) the association between race/ethnicity and mentored K award receipt among U.S. Liaison Committee for Medical Education-accredited medical school graduates who planned research-related careers.

Method: The authors analyzed deidentified data from the Association of American Medical Colleges and the National Institutes of Health Information for Management, Planning, Analysis, and Coordination II grants database for a national cohort of 28,690 graduates from 1997-2004 who planned research-related careers, followed through August 2014. The authors examined 10 potential mediators (4 research activities, 2 academic performance measures, medical school research intensity, degree program, debt, and specialty) of the association between race/ethnicity and mentored K award receipt in models comparing underrepresented minorities in medicine (URM) and non-URM graduates.

Results: Among 27,521 graduates with complete data (95.9% of study-eligible graduates), 1,147 (4.2%) received mentored K awards (79/3,341 [2.4%] URM; 1,068/24,180 [4.4%] non-URM). All variables except debt were significant mediators; together they explained 96.2% (95%, CI 79.1%-100%) of the association between race/ethnicity and mentored K award.

Conclusions: Research-related activities during/after medical school and standardized academic measures largely explained the association between race/ethnicity and mentored K award in this national cohort. Interventions targeting these mediators could mitigate racial/ethnic disparities in the federally funded physician-scientist research workforce.

Figure 1

Path diagram of the mediation model of the association between race/ethnicity and receipt of a mentored K career development award (K01/K08/K23), controlling for sex and graduation year. Potential mediators examined are as follows: medical school research elective, research paper authorship, medical school research intensity, specialty, debt, United States Medical Licensing Examination Step l and Step 2 Clinical Knowledge scores, degree program, ≥ 1 GME-research year, F32 award. Path A represents the association between race/ethnicity and each potential mediator; Path B, the association between each potential mediator and the outcome, K award receipt; and Path C, the association between race/ethnicity and the outcome, K award receipt.