The research arrives at a precarious moment for the American nursing workforce. In 2021, the number of nurses under 35 in the workforce plummeted by more than 100,000 in a single year, a decline significantly higher than any seen in the previous four decades, although updated forecasts suggest the profession is recovering following the COVID-19 pandemic. The National Sample Survey of Registered Nurses projects a national deficit of 78,610 full-time equivalent registered nurses in 2025, easing slightly to 63,720 by 2030. Globally, shortages fueled by an aging, retiring workforce and persistent retention problems compound the crisis. And while the shortage is nationwide, it bites hardest in rural America, where approximately 46 million people live with disproportionately poor access to care.

The health consequences of that scarcity are stark. Rural residents are more likely than urban dwellers to die prematurely from the five leading causes of death: cardiovascular disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Long distances to facilities, inadequate transportation, low insurance rates, limited health literacy, and chronic provider shortages all conspire to worsen outcomes. Between 2012 and 2019, rural populations recorded a 45 percent higher mortality rate from opioid overdose compared with urban areas. The pandemic deepened these divides, bringing lower vaccination rates and higher hospitalization and death rates to rural communities. For farmworkers, the picture is even grimmer: the average life expectancy of a United States farmworker is just 49 years, and chronic disease risk factors such as overweight and obesity, affecting 81 percent of surveyed California agricultural workers, exceed those of the general population.

Against this backdrop, researchers turned to a rural community college nursing program in a region federally designated as both a Medically Underserved Area and a Health Professional Shortage Area, where fewer than 10 percent of residents hold a bachelor’s degree compared with 23 percent nationally. In April 2022, the team invited 87 students from the first- and second-year cohorts of the associate degree registered nursing program to complete a cross-sectional survey, developed through multiple stages of pilot testing and built on questions from validated national surveys. The response was remarkable: 82 students returned surveys, a 91 percent response rate. The study was guided by an intersectionality framework examining how race, gender, and class hierarchies shape experiences within the nursing profession, and a single open-ended question invited students to describe what being a first-generation college nursing student meant to them.

The findings were striking. Approximately 70 percent of participants were first-generation college students, defined under the Higher Education Act as individuals whose parents did not complete a baccalaureate degree. The cohort was overwhelmingly female at 81.7 percent, ethnically diverse, and multilingual: half identified as Hispanic or Latino, one-quarter were fluent in Spanish, and others spoke Tagalog, Cebuano, and other languages. The mean age was 31.54 years, with no significant difference between first-generation and non-first-generation students. Most students were enrolled in a two-year Associate Degree in Nursing program, a pathway researchers note may be more feasible for first-generation students because of its affordability, shorter completion time, and flexibility for those with family caregiving responsibilities.

The statistical comparisons revealed a pattern that defies some conventional assumptions about first-generation disadvantage. While roughly 73 percent of participants were unsure of receiving mentoring support or received none during the admissions process, and while barriers such as the application process, tuition costs, accessing counselors, lack of information, and school distance were common, nearly all of these burdens were shared equally across both groups. Only one dimension separated them: first-generation college students were far more likely to report that high school guidance counselors had questioned their future potential, with 94.4 percent of first-generation students reporting this experience compared with just 5.6 percent of their peers, a statistically significant difference. Even more surprising, first-generation students carried significantly less student loan debt, averaging $4,192 compared with $21,404 for non-first-generation students, though the authors caution that the study did not capture the proportions of student income, living expenses, and tuition that might explain this gap.

The financial portrait of these students is sobering nonetheless. Nearly half reported that their families depended on them as a source of financial support while attending school, and 75.6 percent said their families relied on them for emotional support. Students funded their education through federal or state loans, grants, scholarships, savings, credit cards, and income from work, with nearly a third working part-time and others full-time or on-call. A substantial 31.6 percent reported financial concerns serious enough that they considered dropping out of college. Meanwhile, more than a third struggled to access health care services themselves, and comparable numbers lacked adequate study space, educational materials, transportation, or childcare. Experiences of bias or discrimination related to race, ethnicity, and national origin were reported about 7 percent of the time.

Yet the qualitative responses revealed a powerful undercurrent of purpose. Content analysis of the open-ended question identified five themes: breaking the cycle, financial challenges, empowerment and pride, pressure and uncertainty, and gratitude and motivation. One student captured the duality of the experience: being a first-generation college student is empowering and scary, empowering because she is able to break the chain and scary because there are many unknowns about the process. Others described breaking barriers and stigma, setting an example for younger siblings, and pursuing opportunities their parents never had. Many spoke of honoring parental sacrifice, with one student writing that accomplishing a college degree means the whole world to her, and another hoping to motivate her son, nieces, and nephews to continue their education.

Perhaps the most consequential finding for workforce policy is the students’ commitment to the communities that produced them. A significantly greater proportion of first-generation students grew up in rural or designated low-income areas, at 88 percent compared with 12 percent of non-first-generation peers. And while 40.2 percent of all respondents planned to work in under-resourced communities after finishing their schooling, first-generation students were dramatically more likely to express that intention, comprising 87.9 percent of those affirmatively interested versus 12.1 percent of non-first-generation students. The students also expressed overwhelming interest in continuing their education beyond the associate degree: 89.2 percent planned to complete a Bachelor of Science in Nursing within one to three years, 59.1 percent intended to pursue master’s-level education, and 31.5 percent showed interest in doctoral study.

The implications ripple outward from this single rural campus. Research consistently shows that culturally, socially, and racially concordant care, in which providers mirror the patients they serve, produces significantly better health outcomes and patient satisfaction. Yet only about 10 percent of registered nurses in the United States are Latinx, even as Latinos constitute California’s largest ethnic group at 15 million people and the state holds the most diverse older population in the nation. First-generation college healthcare providers may bring a unique perspective on the experiences of patients from similar backgrounds, strengthening patient-provider relationships and outcomes. The authors acknowledge limitations, including the cross-sectional design, the single rural site, and the focus on community college students, which may limit generalizability to baccalaureate and graduate programs or to first-generation students in other regions. Still, their conclusion is clear: recruiting and retaining first-generation college nurses represents a tangible, evidence-supported strategy for tackling nursing workforce shortages in underserved rural areas, one that requires concerted effort from policymakers, healthcare providers, and community members alike. For the students themselves, the mission is already personal. They are not merely filling workforce gaps; they are breaking a generational cycle, one degree at a time, in the communities that need them most.

Subject of Research: Experiences and workforce potential of first-generation college nursing students at a rural community college

Article Title: Breaking the Cycle: First‐Generation College Nursing Students Attending a Rural Community College

Article References: Arriaga, A. T., Castillo, E., Chan, G. K., & Wagner, L. M. (2026). Breaking the Cycle: First‐Generation College Nursing Students Attending a Rural Community College. Nursing Open, 13(10), Article e70878. https://doi.org/10.1002/nop2.70878

Image Credits: AI Generated

DOI: 10.1002/nop2.70878

Keywords: nursing workforce, first-generation college students, rural health, community college, health disparities, nursing education, farmworker health, California, registered nurses, health professional shortage areas, student loan debt, workforce diversity

The research stands out for the strength of its data source. Previous attempts to measure disability among physicians have typically relied on voluntary surveys, which raise concerns about who chooses to respond and whether the resulting samples truly represent the profession. This study instead drew on the 2021 Canadian long-form Census, a mandatory questionnaire completed by a randomly selected 25 percent of the population living in Canada, with a completion rate of 97 percent. Because participation is legally required rather than optional, the census offers a nationally representative picture that voluntary surveys struggle to match. That methodological advantage matters in a field where underreporting and nonresponse can easily distort estimates of how common disability really is among health professionals.

The most frequently reported category of disability among physicians was mental health, accounting for 40 percent of reported disabilities. Visual disabilities followed at 37 percent, then hearing disabilities at 15 percent, mobility or physical disabilities at 13 percent, and cognitive or learning disabilities at 6 percent. The prominence of mental health conditions at the top of the list is notable in a profession where burnout, long hours, and emotional strain have been widely documented, and where stigma has historically discouraged clinicians from acknowledging psychological difficulties. The high proportion of visual disabilities, meanwhile, underscores that disability in medicine spans a broad range of sensory and physical experiences rather than being confined to any single category.

The study also uncovered demographic patterns that challenge common assumptions about who is affected. Disabilities were reported more often by female physicians, at 6.0 percent, than by male physicians, at 4.5 percent. Age shaped the profile of disability in ways that varied by condition. While overall disability rates generally increased with age, the prevalence among physicians younger than 35 years remained notable at 5.2 percent. Hearing, mobility, and physical disabilities became more common in older age groups, consistent with the cumulative effects of aging, whereas mental health disabilities were more concentrated among younger physicians. The authors emphasize that younger age does not preclude disability, a point with direct implications for how medical training programs and early-career workplaces design their support systems.

Perhaps the most striking comparison in the study is with other professions. Physicians reported fewer disabilities than workers in law, academia, engineering, and nursing, as well as fewer than the general workforce. The authors and commentators suggest several plausible explanations for this gap, and the data alone cannot distinguish among them. It may reflect a genuine lower prevalence, but it could also reflect barriers that discourage people with disabilities from entering or remaining in medicine, or reluctance among physicians to disclose disability in a profession that has traditionally prized physical stamina, long shifts, and an image of personal invulnerability. Whatever the mechanism, a workforce that reports less disability than nearly any comparable profession raises questions about whether medicine is truly as inaccessible as the numbers imply beneath the surface.

The consequences of inaction extend well beyond the affected individuals. As Dr. Michael Quon, a general internal medicine specialist and clinician investigator at The Ottawa Hospital and an assistant professor at the University of Ottawa, wrote with his coauthors, physicians with disabilities frequently face discrimination, inaccessible workplaces, and inadequate support. When such physicians leave the workforce or never enter it in the first place, the health system loses skilled providers with valuable perspectives at a time when human health resources are stretched thin across Canada. Retention, in this framing, is not a matter of accommodation as charity but of workforce economics: every physician lost to an inaccessible work environment represents years of training and clinical expertise that patients can no longer benefit from.

The authors frame disability as an important yet often overlooked contributor to workforce diversity. Diversity initiatives in medicine have traditionally focused on dimensions such as gender, race, and socioeconomic background, while disability has received comparatively little systematic attention in recruitment, training, and workplace policy. The census-based findings give that argument empirical weight. With one in six physicians reporting disability at least sometimes, disability is not a marginal concern affecting a tiny minority but a mainstream workforce reality. Policies designed without this population in mind, from scheduling practices to physical infrastructure to leave and return-to-work processes, risk failing a significant fraction of the clinical workforce.

There is also a patient-care dimension to the argument. The authors suggest that advancing accessibility might enhance care by fostering a workforce that better reflects the populations it serves. Many patients live with disabilities, and physicians who have firsthand experience of navigating inaccessible environments, adaptive equipment, or chronic health conditions may bring distinctive insight to those clinical encounters. A medical profession that mirrors the diversity of disability in the general population is better positioned to communicate with, understand, and advocate for disabled patients. In this sense, accessibility for physicians is not only an internal workforce issue but a pathway toward more equitable care for the public.

The study’s practical implications point toward concrete changes. Ensuring accessible work environments and equitable policies, the authors write, can promote the well-being and retention of physicians with disabilities and support those seeking to return to practice. That agenda touches medical schools and residency programs, which shape who enters the profession; hospitals and clinics, which control the physical and procedural environments in which care is delivered; and licensing and professional bodies, which set the standards that determine whether disclosure carries risk or protection. Because mental health disabilities dominate the list and cluster in younger physicians, stigma reduction and confidential support services emerge as particularly urgent priorities for the next generation of the workforce.

What the census data cannot show is equally important for interpreting the findings. The survey captures self-reported disability at a point in time and does not identify which physicians left the profession because of inaccessible conditions, nor does it measure the severity of the barriers encountered. Still, by establishing a nationally representative baseline, the study gives researchers, policymakers, and professional organizations a rigorous foundation for tracking progress. The authors’ central message is straightforward: improving accessibility in medicine is important, and the evidence now shows why. A health system that supports its own members with disabilities is better equipped to sustain its workforce, retain its expertise, and serve a population in which disability is a common part of human experience.

Subject of Research: Prevalence and characteristics of disability among practising physicians in Canada based on census data

Article Title: Physicians have disabilities too: New research calls for a more accessible medical workforce

Article References: Physicians have disabilities too: New research calls for a more accessible medical workforce. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: physicians, disability, Canada, workforce, accessibility, mental health, Canadian Medical Association Journal, census data, workforce diversity, health policy, retention, medical education

To understand the argument, it helps to revisit what Abraham Flexner actually did. Commissioned by the Carnegie Foundation, Flexner toured medical schools across the United States and Canada and delivered a devastating assessment of a profession with weak oversight, inconsistent curricula, and thin scientific grounding. His remedy was sweeping: standardized curricula and assessment, formal university affiliation, faculty scholarship, laboratory training, and a curriculum anchored in basic science and clinical application. Drawing on German models that emphasized research and formal instruction, Flexner sought to make physicians better prepared and patients safer. By those measures, the report succeeded spectacularly, and it established the organizing principles that still govern medical education today.

But the reforms carried a hidden price. Consolidating training within well-resourced academic institutions forced the closure of schools that could not meet the new standards, and the burden fell unevenly. Of the seven historically Black medical schools operating in 1910, five closed, leaving only Howard University and Meharry Medical College. These institutions had been chronically underfunded, excluded from major teaching hospitals, and largely ignored by donors, making them acutely vulnerable to standards they had no resources to meet. Flexner himself held views that reflected the racial attitudes of his era, suggesting that Black physicians should focus on basic care and disease prevention in Black communities rather than full professional equality, a stance that influenced which schools survived.

Women in medicine faced a parallel contraction. Flexner acknowledged that women were formally admitted to most schools but attributed their low enrollment to declining interest rather than structural barriers, and he suggested their aptitude was best suited to fields such as maternal and child health. The closure of women’s medical schools and their consolidation into male-dominated institutions reduced pathways for women physicians and contributed to a prolonged decline in women’s representation across much of the twentieth century. Together, the authors write, these reforms contracted access to medicine for Black individuals and women by a full generation, and surgical education, concentrated ever more tightly within elite academic centers, amplified the exclusion.

The demographic echoes are measurable today. According to data cited in the analysis, Black individuals made up 11.6 percent of the U.S. population in 1900 but only 1.3 percent of physicians; by 1940 the figures were 9.7 percent and 2.8 percent. Currently, Black Americans represent roughly 13.4 percent of the population but only 7.8 percent of general surgery residents, while women account for just 37.9 percent of general surgery residents according to recent Association of American Medical Colleges data. Women comprise approximately 39 percent of fellowship trainees after general surgery residency, a pattern the authors link to persistent attrition discrepancies across the surgical training continuum. Of the four Historically Black Colleges and Universities with affiliated accredited medical schools today, only Howard University and Morehouse School of Medicine operate surgical residency programs, yet HBCUs continue to produce a disproportionately high share of Black physicians, faculty, and academic leaders.

Federal policy has repeatedly tried to repair the damage. Title VII programs, Medicare Graduate Medical Education funding, and affirmative action policies aimed to expand opportunity and address historical inequities. The physician shortage that Flexner-era consolidation helped create was partly offset by the Immigration and Nationality Act of 1965, which opened the door to international medical graduates who became essential to primary care, rural, and safety-net settings. That reliance, however, carries global costs, including the migration of highly trained professionals away from low-resource countries, a phenomenon known as brain drain, along with ongoing workforce inequities for international graduates themselves. The authors argue that the United States built a health system dependent on physicians trained abroad while constructing an immigration environment that keeps their presence perpetually uncertain, a structural inequity deserving the same scrutiny as domestic disparities.

The paper also sounds a contemporary warning. Executive orders issued in 2025, including Orders 14,148, 14,151, and 14,173, revoked workforce guidance for underrepresented groups, paused or rescinded diversity initiatives, and removed race- and gender-based preferences in federal programs. The authors draw a direct line between these actions and Flexner’s reforms: both were presented as neutral and merit-based, yet both risk ignoring unequal starting points and structural barriers that continue to shape outcomes. The lesson, they contend, is that reforms can pursue excellence and still cause harm when they ignore equity, and that good intentions alone are insufficient.

Against this historical backdrop, the analysis examines the machinery of modern evaluation. The Liaison Committee on Medical Education, established in 1942, and the Accreditation Council for Graduate Medical Education now serve as central levers for fairness in training. Although the LCME does not explicitly frame its standards around bias, requirements such as ED-21 and ED-23 mandate education in cultural competence and health disparities, while ED-30, ED-33, and ED-46 emphasize fair assessment and continuous quality improvement, and IS-23 supports holistic admissions. At the residency level, the Clinical Competency Committee, introduced by the ACGME in 2013 alongside the Next Accreditation System and the Milestones Project, replaced informal, program-director-driven assessment with structured, committee-based review of multiple data sources. That group-based deliberation protects individual trainees by reducing reliance on single evaluators and minimizing biased decision-making, and it can surface microaggressions that individual evaluations miss. The Program Evaluation Committee performs the analogous function at the program level, replacing episodic inspection with continuous, data-driven oversight of trainee satisfaction, patient outcomes, and recruitment.

Institutional culture, the authors stress, follows from leadership. They point to Washington University School of Medicine in St. Louis, which through formal anti-racism commitments, health equity curricula, and an Executive Faculty Task Force reported an 82 percent increase in underrepresented faculty and a 46 percent increase in female faculty, evidence that change requires structural investment rather than individual goodwill. Looking forward, the paper proposes evaluation frameworks that extend beyond operative volumes, milestone progression, and board pass rates to measure culture, belonging, mentorship, retention, empowerment, and leadership advancement, pairing quantitative metrics with focus groups, interviews, 360-degree evaluations, and climate surveys. Pathway programs such as Tulane’s IMPRESS and the University of Alabama at Birmingham’s PRISM and SURE initiatives have reported strong outcomes, with more than 93 percent of participants showing increased understanding of healthcare careers and 93 percent describing an enhanced sense of belonging in medicine. Federal agencies including HRSA, the National Institute on Minority Health and Health Disparities, and ARPA-H are increasingly funding such efforts, signaling a policy shift toward investing in human capital as a driver of both equity and excellence.

The ultimate message of the analysis is that excellence is neither static nor value neutral. Flexner established the importance of standards and accountability, yet his legacy demonstrates how reforms that ignore structural inequities can produce lasting harm. Contemporary accreditation, evaluation, and policy frameworks, the authors argue, offer an opportunity to reconcile those lessons by aligning educational quality with inclusion and social responsibility. Only by integrating historical awareness with equity-centered evaluation, they conclude, can the profession sustain a highly skilled and diverse surgical workforce capable of meeting the needs of the patients and societies it serves.

Subject of Research: Historical and equity-informed evaluation of surgical education programs from the Flexner era to modern accreditation policy

Article Title: Program evaluation and policy implications in surgical education: from flexner to the modern pursuit of access and excellence

Article References: Luo, X., Holmes, C., Pai, J., Rhodes, C., Bain, A., Paramesh, A., & Turner, J. (2026). Program evaluation and policy implications in surgical education: from flexner to the modern pursuit of access and excellence. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 141. https://doi.org/10.1007/s44186-026-00546-y

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00546-y

Keywords: Flexner Report, surgical education, medical education, health equity, workforce diversity, ACGME, LCME, program evaluation, international medical graduates, residency training, holistic admissions, pathway programs

The urgency motivating the program is demographic as much as educational. The United States faces a projected shortage of physicians, including surgeons, with the burden expected to fall hardest on rural and underserved communities. Previous studies cited by the authors have documented particular strain in rural and frontier counties, where general surgeon shortages translate directly into delayed operations, longer travel distances for patients, and worse outcomes for time-sensitive conditions such as trauma and appendicitis. Workforce projections extending to 2036 suggest that the problem will deepen without deliberate intervention, making the recruitment of future surgeons a matter of public health rather than simply professional preference.

Diversity is the second pillar of the program’s rationale. A substantial body of evidence links a physician workforce that reflects the population it serves to measurable improvements in patient care. Research summarized in the report indicates that underrepresented minority physicians are more likely to care for vulnerable populations, that racial and ethnic concordance between patients and physicians is associated with better communication and trust, and that representation of Black primary care physicians correlates with population-level life expectancy and mortality metrics. Yet students from historically underrepresented backgrounds continue to encounter structural barriers to medical careers, among the most fundamental of which is limited early exposure to healthcare professions. Many adolescents never meet a surgeon, let alone handle the instruments of the trade.

Pathway programs have emerged over the past several decades as a response to this exposure gap, but the FAST authors argue that many existing initiatives suffer from a common weakness: they lack scalable models and practical implementation guidance. A program that works at a single institution with a handful of motivated volunteers may collapse when attempts are made to replicate it elsewhere. The FAST report is explicitly designed to counter this by laying out the program’s planning processes, logistics, execution details, and hard-won lessons, offering what amounts to an open-source framework for organizations hoping to build similar initiatives.

The mechanics of a FAST event reveal why the model has proven durable. Each event is structured as a multi-station interactive experience rather than a lecture or career fair. Students rotate through stations that include surgical simulation, hands-on suturing and knot-tying instruction, anatomy demonstrations, and structured discussions of healthcare career pathways. The simulation components are particularly consequential: research on basic surgical skills education has shown that early experiential contact with surgical techniques can shift students’ attitudes toward surgical careers and accelerate skills acquisition. By letting teenagers physically perform the fundamental tasks of surgery, even in simplified form, the program converts an abstract career option into a concrete, memorable experience.

Scale has grown steadily. FAST events now engage approximately 80 to 150 students and 30 to 50 volunteers annually, drawing on surgeons across a wide range of clinical specialties. The authors describe FAST as one of the earliest and largest national efforts to bring high school students into direct contact with practicing surgeons in this way, unified by a shared commitment to education. The volunteer corps includes academic surgeons, trainees, and allied professionals, and the program has been supported by institutional partners and industry sponsors who contribute equipment, materials, and logistical assistance, from surgical simulation technology to basic event supplies.

Three operational factors stand out in the authors’ account as critical to successful implementation. The first is sustainable funding: outreach programs that depend on year-to-year improvisation tend to be fragile, and FAST’s stability has rested on institutional support from the Association for Surgical Education combined with contributions from partner organizations and sponsors. The second is structured volunteer coordination. With dozens of volunteers per event, many of them busy clinicians, the program requires clear role definitions, advance communication, and reliable on-site organization to function smoothly. The third is early engagement with local schools and surgeons, which ensures that students actually attend, that chaperones and institutional permissions are in place, and that local surgical communities feel ownership of the event.

The report is candid about the distinction between pipelines and pathways, a conceptual shift that has gained traction in education research. A pipeline metaphor implies a linear, passive flow of students through a fixed sequence, whereas a pathway framework emphasizes active, student-centered progression with multiple entry and exit points. This reframing matters because attrition in academic achievement and disciplinary disparities begin well before college, meaning that a single contact point in high school cannot carry the entire burden of workforce diversification. Pathway thinking encourages programs like FAST to position themselves as one node in a longer network of mentorship and support rather than as a standalone solution.

The evidence base for early outreach is encouraging but still developing. Studies of mini-medical school programs have found that they decrease perceived barriers to medical careers among underrepresented minority high school students, and evaluations of surgical high school outreach programs have reported positive effects on the career trajectories of underserved students. Systematic reviews of barriers facing Black premedical students and of diversity within surgical residency education confirm that the obstacles are cumulative and structural, spanning financial constraints, limited mentorship, and institutional culture. Programs that intervene early, provide visible role models, and offer hands-on contact address the earliest and arguably most formative of these barriers.

The FAST authors frame their ultimate goal in terms of health equity rather than workforce statistics alone. Diversifying the physician workforce, they argue, is essential to improving care delivery and advancing equity, and pathway programs play a critical role in supporting learners who are most vulnerable and historically marginalized. By publishing the tools, structures, and lessons learned from a decade of FAST events, the team has effectively lowered the barrier for surgical societies, hospitals, and medical schools elsewhere to launch their own initiatives. If the projected surgeon shortage materializes as forecast, the students now fumbling their first square knots at FAST stations may prove to be among the most consequential recruits the profession secures.

Subject of Research: A national surgical pathway program introducing high school students to surgical careers through hands-on outreach to address workforce shortages and diversity gaps

Article Title: Finding aspiring surgeons of tomorrow (FAST): a decade of lessons learned building a national surgical pathway program

Article References: Buonpane, C. L., Sanchez, S. E., Sheppard, O. O., Deckard, M. L., Kreinik, J. N., & Arora, T. K. (2026). Finding aspiring surgeons of tomorrow (FAST): a decade of lessons learned building a national surgical pathway program. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 147. https://doi.org/10.1007/s44186-026-00552-0

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00552-0

Keywords: surgical education, pathway programs, workforce diversity, high school outreach, surgeon shortage, health equity, mentorship, medical education, surgical simulation, healthcare workforce, Association for Surgical Education, rural health

The research team, led by Mia F. Williams, MD, MS, and Rachel Schwartz, PhD, of the University of California, San Francisco, together with Colleen A. McGourty, Crystal Liang, and Mitchell D. Feldman, conducted semi-structured qualitative interviews with fifteen leaders within a large academic Department of Medicine. The participants ranged from division and section chiefs all the way up to the dean’s office, capturing perspectives from those who control access to many of the opportunities that determine advancement in medical academia. The researchers used an inductive thematic analysis approach, coding the interview data to identify patterns in how leaders described their sponsorship practices, their understanding of the sponsor role, the principles guiding their decisions, and their views on what institutions could do better.

Perhaps the study’s most striking finding is its universality: every single leader interviewed engaged in sponsorship. Yet their conceptions of what sponsorship meant varied widely. Some leaders saw it simply as an embedded part of their leadership responsibilities, something they did routinely without special reflection. Others described it as a passion and a core mission, framing sponsorship as central to their identity as leaders and to their obligation to cultivate the next generation of academic physicians. This variation matters, the authors argue, because sponsorship often occurs out of sight, without metrics or tracking mechanisms, which means the distribution of sponsored opportunities may depend heavily on each individual leader’s style, awareness, and priorities rather than on any consistent institutional standard.

What drives a leader to sponsor one faculty member over another? The interviews surfaced several recurring factors. Familiarity with potential sponsees loomed large, including their previous and potential performance and the clarity of their career goals. Leaders described watching for faculty who demonstrated excellence and ambition, then deliberately connecting them with opportunities such as leadership roles, high-profile projects, and introductions to influential colleagues. Another prominent theme was equity in the distribution of opportunities. Some leaders consciously worked to spread sponsored chances across their faculty rather than concentrating them on a favored few, while others acknowledged that sponsorship naturally flows through relationships and networks, raising questions about who gets noticed and who remains invisible.

That network dependence emerged as a double-edged sword in the findings. Leaders emphasized that effective sponsorship relies on robust professional networks and institutional influence, their own accumulated social capital being the raw material they spend when they vouch for someone. As one theme captured in the study’s title suggests, leaders described sponsorship in vivid terms of access: they can open doors that remain closed to others. But social capital is unevenly distributed, and prior research cited by the team, including a 2024 scoping review by Schwartz, Williams, and Feldman, has questioned whether sponsorship actually promotes equity in career advancement in academic medicine or instead amplifies existing disparities. Studies of gender differences in sponsorship, including work on National Institutes of Health grant recipients and on women in anesthesiology and emergency medicine, suggest that men are more likely to be sponsored into positions of influence, and that women and faculty from underrepresented groups often face narrower pathways to the networks that sponsorship requires.

The leaders themselves recognized this tension. Interviewees highlighted the inherent bias embedded in sponsorship practices, acknowledging that informal, relationship-driven advocacy tends to favor those who resemble the sponsors or who already move in the same professional circles. Several participants called for additional infrastructure to support equitable sponsorship, arguing that institutions cannot rely on individual goodwill alone to level the playing field. This aligns with a growing body of literature arguing that mentorship is not enough: as Ayyala and colleagues wrote in Academic Medicine in 2019, career advancement in academic medicine requires deliberate sponsorship structures, and Gottlieb and Travis argued in 2018 that the time for formal sponsorship models is now.

Even the most committed sponsors in the study faced significant barriers. Inadequate time was the most commonly cited obstacle; sponsorship is labor-intensive, requiring leaders to make introductions, advocate in meetings, and follow through on commitments, all on top of clinical, research, and administrative duties. Uncertainty about best practices compounded the problem, with leaders unsure whether they were sponsoring effectively or fairly. A lack of institutional support rounded out the barriers: because sponsorship is invisible and unmeasured, leaders receive little recognition for doing it well and no feedback when they fall short. The result is a system in which the engine of career advancement runs on personal initiative rather than institutional design.

The study’s conclusions point toward concrete reform. Williams and her colleagues call for explicit definitions of sponsorship, transparency about how sponsored opportunities are allocated, and institutional support structures that make sponsorship visible, accountable, and equitable. Practical implications could include tracking who receives sponsored opportunities, training leaders in sponsorship practices, building formal sponsorship programs that pair faculty with senior advocates, and embedding sponsorship expectations into leadership job descriptions. Such measures, the authors argue, are essential to promote equitable career advancement, particularly for women and underrepresented minority faculty who research shows are less likely to benefit from informal sponsorship networks. In a field where positions of power remain disproportionately concentrated, the difference between a mentor who advises and a sponsor who opens the door may be the difference between a stalled career and a leadership role.

For the broader scientific and medical community, the study is a reminder that career pipelines are not built on merit alone. The invisible labor of door-opening shapes who becomes a department chair, who sits on national panels, and whose research gets amplified. Making that labor visible is the first step toward ensuring it serves everyone. As academic medicine confronts persistent disparities in its leadership ranks, this research suggests that the question is no longer whether leaders should sponsor their faculty, since all of them already do, but whether institutions will finally build the scaffolding to make that sponsorship deliberate, transparent, and fair.

Subject of Research: Sponsorship roles and practices among leaders in academic medicine and their impact on equitable faculty career advancement

Article Title: “I Can Open the Door”: Sponsorship Roles and Practices in Academic Medicine

Article References: Williams, M. F., Schwartz, R., McGourty, C. A., Liang, C., & Feldman, M. D. (2026). “I Can Open the Door”: Sponsorship Roles and Practices in Academic Medicine. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10573-6

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10573-6

Keywords: sponsorship, academic medicine, mentoring, career advancement, faculty development, workforce diversity, gender equity, leadership, qualitative research, professional networks, Open, Door

The findings, led by Neil S. Zhang and Atif Qasim of the University of California, San Francisco, along with collaborators at Creighton University and the Kirk Kerkorian School of Medicine at UNLV, are striking in their clarity. Overall, 32,091 of the 38,179 applicants, or 84.1 percent, successfully entered the subspecialty to which they applied. But that aggregate success rate conceals dramatic differences among applicant groups. Research productivity emerged as the single most powerful predictor: applicants with 11 or more publications had 4.18 times higher odds of success compared with those who had none, a stronger association than any other characteristic examined.

The study leveraged a unique combination of databases. Applicant characteristics came from the Electronic Residency Application Service, or ERAS, administered by the Association of American Medical Colleges, and were linked to the AAMC’s Graduate Medical Education Track, a national registry of trainees at every residency and fellowship program. An applicant was defined as successful if he or she appeared in GME Track as a fellow in the same subspecialty during the corresponding appointment year. The researchers excluded applicants who applied to more than one subspecialty, applied in multiple years, or had masked ages, yielding a cohort of single-time applicants to cardiovascular disease, endocrinology, gastroenterology, hematology and oncology, infectious disease, pulmonary and critical care medicine, nephrology, and rheumatology.

Statistically, the team used multivariable logistic regression to isolate the effect of each characteristic while adjusting for all others, along with the subspecialty and application year. Predictive margins were estimated to calculate adjusted probabilities of success for different applicant groups across publication categories. The cohort had a median age of 31 years, and 41.2 percent were female, 9.5 percent identified as underrepresented in medicine, and 39.6 percent were international medical graduates. Chief resident status, additional graduate degrees such as a PhD or master’s degree, and training in larger residency programs with 55 or more residents all independently boosted the odds of success.

Against these advantages, several groups faced measurable headwinds. Each additional year of age was associated with lower odds of success. After adjustment, female applicants had 0.89 times the odds of success, underrepresented-in-medicine applicants 0.84 times, osteopathic DO graduates 0.53 times, and international medical graduates just 0.44 times the odds of their counterparts. Graduates of community-based residency programs and community-based, university-affiliated programs were likewise significantly less likely to succeed than those from university-based programs, a pattern the authors attribute in part to the weight program directors place on the perceived reputation of the training institution.

The subspecialty-level breakdown sharpened the picture. The disadvantage for female applicants was most pronounced in cardiovascular disease and gastroenterology, where women had 0.79 times the odds of success, while the penalty for underrepresented-in-medicine applicants was especially evident in pulmonary and critical care medicine, at 0.59 times the odds. The payoff for research output also varied: the association between 11 or more publications and success was particularly strong in gastroenterology, pulmonary and critical care medicine, and endocrinology, though notably absent in infectious disease. Analyses restricted to the four most competitive subspecialties suggested that many of these disadvantages grew even larger in the toughest markets.

One of the most consequential findings concerns whether publications can compensate for baseline disadvantage. Predictive margins showed that success rose with publication count for every applicant group. For underrepresented-in-medicine applicants, the gap with non-underrepresented peers appeared to narrow at higher publication counts, although interaction testing did not reach statistical significance, likely because few such applicants reached the highest publication category. More sobering was the finding that the disadvantages experienced by female and DO applicants persisted at every level of research productivity, showing no attenuation whatsoever. International medical graduates gained more from each additional publication than their MD counterparts, yet even this larger benefit failed to erase their baseline gap entirely.

The authors frame these results as evidence of a self-reinforcing research arms race. Program director surveys consistently rank research involvement and perceived interest in scholarship among the most important selection factors, prompting applicants to accumulate ever more publications, which in turn pushes programs to value the metric even more. Prior work suggests many of these entries are never cited, raising concerns about the quality of the science behind the numbers. The ERAS publications variable aggregates journal articles, abstracts, book chapters, and presentations into a single count, so a first-author paper in a major journal currently carries the same statistical weight as a poster at a regional meeting, a limitation the researchers say should be addressed in future studies.

As a remedy, the study advocates for Mission-aligned Selection, a framework promoted by the AAMC that emphasizes individualized, systematic review of applicants’ experiences, attributes, and academic metrics in light of each program’s mission. Early adopters offer encouraging signals: after one pulmonary and critical care fellowship implemented holistic review practices, its faculty ranked publications among the least important metrics, and a pediatric surgery fellowship reported that the caliber of its interviewees actually improved. The authors also point to preference signaling, now available in several internal medicine subspecialties, as a tool that may reduce defensive over-application, though its effects on equity remain unproven. They caution that qualitative materials central to holistic review, such as letters of recommendation, have been shown to contain biased language toward female and underrepresented applicants, so standardization efforts must accompany any shift away from raw publication counts.

The study’s limitations are worth noting. Because direct match data were not available, success was defined as entering the subspecialty rather than formally matching, though out-of-match placements likely represent a small minority. Factors such as board scores, honors, interview ratings, and personal statements were unavailable, leaving room for residual confounding. Still, as the first comprehensive, individual-level national analysis of its kind, the work makes the structure of the fellowship selection process unusually visible. Its message is twofold: research output overwhelmingly determines who gets in, and the system as currently constituted systematically favors younger, male, non-underrepresented, US MD graduates at large university programs. Whether programs and their governing bodies embrace mission-aligned processes may determine not only individual careers but also the future diversity and representativeness of the internal medicine subspecialty workforce.

Subject of Research: Factors associated with successful entry into internal medicine subspecialty fellowships

Article Title: Characteristics and Success of Internal Medicine Applicants to Subspecialty Fellowships

Article References: Zhang, N. S., Tun, K. M., Batra, K., Babik, J. M., Huppert, L., Singh, A., Wahi-Gururaj, S., & Qasim, A. (2026). Characteristics and Success of Internal Medicine Applicants to Subspecialty Fellowships. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10688-w

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10688-w

Keywords: internal medicine, fellowship match, graduate medical education, publications, underrepresented in medicine, international medical graduates, osteopathic medicine, mission-aligned selection, ERAS, cardiology, pulmonary critical care, workforce diversity