Racial and Ethnic Differences in Internal Medicine Residency Assessments
Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education. To examine the association between race a...
Gespeichert in:
| Veröffentlicht in: | JAMA network open 2022-12, Vol.5 (12), p.e2247649-e2247649 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e2247649 |
|---|---|
| container_issue | 12 |
| container_start_page | e2247649 |
| container_title | JAMA network open |
| container_volume | 5 |
| creator | Boatright, Dowin Anderson, Nientara Kim, Jung G Holmboe, Eric S McDade, William A Fancher, Tonya Gross, Cary P Chaudhry, Sarwat Nguyen, Mytien Nguemeni Tiako, Max Jordan Colson, Eve Xu, Yunshan Li, Fangyong Dziura, James D Saha, Somnath |
| description | Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.
To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.
This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.
The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.
The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P |
| doi_str_mv | 10.1001/jamanetworkopen.2022.47649 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2759264421</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2759217723</sourcerecordid><originalsourceid>FETCH-LOGICAL-a418t-29d3cf91c1fe883874a6613e93376cd107bb8ce486b47c27f89218b5d3438303</originalsourceid><addsrcrecordid>eNpdkFtLwzAUgIMobsz9BSn64ktnbm1S38acTpgIY-8hTU8xs01n0iL793ZuiuzpHDjfuX0I3RA8IRiT-42utYP2q_EfzRbchGJKJ1ykPDtDQ5oIHjOJk_N_-QCNQ9hgjCkmLEuTSzRgaSIxY2KIFittrK4i7Ypo3r47a6JHW5bgwRkIkXXRi2vBux55hcIa6yBaQbBFX99F0xAghBpcG67QRamrAONjHKH103w9W8TLt-eX2XQZa05kG9OsYKbMiCElSMmk4DpNCYOsvyY1BcEiz6UBLtOcC0NFKTNKZJ4UjDPJMBuhu8PYrW8-Owitqm0wUFW9lKYLiookoynnlPTo7Qm6abr9J0eKCEFZTz0cKOObEDyUauttrf1OEaz2xtWJcbU3rn6M983XxxVdXkPx1_rrl30DjbV_0w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2759217723</pqid></control><display><type>article</type><title>Racial and Ethnic Differences in Internal Medicine Residency Assessments</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Alma/SFX Local Collection</source><source>EZB Electronic Journals Library</source><creator>Boatright, Dowin ; Anderson, Nientara ; Kim, Jung G ; Holmboe, Eric S ; McDade, William A ; Fancher, Tonya ; Gross, Cary P ; Chaudhry, Sarwat ; Nguyen, Mytien ; Nguemeni Tiako, Max Jordan ; Colson, Eve ; Xu, Yunshan ; Li, Fangyong ; Dziura, James D ; Saha, Somnath</creator><creatorcontrib>Boatright, Dowin ; Anderson, Nientara ; Kim, Jung G ; Holmboe, Eric S ; McDade, William A ; Fancher, Tonya ; Gross, Cary P ; Chaudhry, Sarwat ; Nguyen, Mytien ; Nguemeni Tiako, Max Jordan ; Colson, Eve ; Xu, Yunshan ; Li, Fangyong ; Dziura, James D ; Saha, Somnath</creatorcontrib><description>Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.
To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.
This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.
The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.
The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P < .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P < .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P < .001). By the final year 3 assessment, the gap between White and Asian and URiM residents' scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training.
In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2022.47649</identifier><identifier>PMID: 36580337</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Cohort analysis ; Cohort Studies ; Cultural differences ; Education, Medical, Graduate ; Ethnicity ; Female ; Hispanic people ; Humans ; Internal medicine ; Internship and Residency ; Male ; Medical education ; Medicine ; Retrospective Studies</subject><ispartof>JAMA network open, 2022-12, Vol.5 (12), p.e2247649-e2247649</ispartof><rights>2022. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a418t-29d3cf91c1fe883874a6613e93376cd107bb8ce486b47c27f89218b5d3438303</citedby><cites>FETCH-LOGICAL-a418t-29d3cf91c1fe883874a6613e93376cd107bb8ce486b47c27f89218b5d3438303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,860,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36580337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boatright, Dowin</creatorcontrib><creatorcontrib>Anderson, Nientara</creatorcontrib><creatorcontrib>Kim, Jung G</creatorcontrib><creatorcontrib>Holmboe, Eric S</creatorcontrib><creatorcontrib>McDade, William A</creatorcontrib><creatorcontrib>Fancher, Tonya</creatorcontrib><creatorcontrib>Gross, Cary P</creatorcontrib><creatorcontrib>Chaudhry, Sarwat</creatorcontrib><creatorcontrib>Nguyen, Mytien</creatorcontrib><creatorcontrib>Nguemeni Tiako, Max Jordan</creatorcontrib><creatorcontrib>Colson, Eve</creatorcontrib><creatorcontrib>Xu, Yunshan</creatorcontrib><creatorcontrib>Li, Fangyong</creatorcontrib><creatorcontrib>Dziura, James D</creatorcontrib><creatorcontrib>Saha, Somnath</creatorcontrib><title>Racial and Ethnic Differences in Internal Medicine Residency Assessments</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.
To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.
This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.
The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.
The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P < .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P < .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P < .001). By the final year 3 assessment, the gap between White and Asian and URiM residents' scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training.
In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.</description><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Cultural differences</subject><subject>Education, Medical, Graduate</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Hispanic people</subject><subject>Humans</subject><subject>Internal medicine</subject><subject>Internship and Residency</subject><subject>Male</subject><subject>Medical education</subject><subject>Medicine</subject><subject>Retrospective Studies</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkFtLwzAUgIMobsz9BSn64ktnbm1S38acTpgIY-8hTU8xs01n0iL793ZuiuzpHDjfuX0I3RA8IRiT-42utYP2q_EfzRbchGJKJ1ykPDtDQ5oIHjOJk_N_-QCNQ9hgjCkmLEuTSzRgaSIxY2KIFittrK4i7Ypo3r47a6JHW5bgwRkIkXXRi2vBux55hcIa6yBaQbBFX99F0xAghBpcG67QRamrAONjHKH103w9W8TLt-eX2XQZa05kG9OsYKbMiCElSMmk4DpNCYOsvyY1BcEiz6UBLtOcC0NFKTNKZJ4UjDPJMBuhu8PYrW8-Owitqm0wUFW9lKYLiookoynnlPTo7Qm6abr9J0eKCEFZTz0cKOObEDyUauttrf1OEaz2xtWJcbU3rn6M983XxxVdXkPx1_rrl30DjbV_0w</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Boatright, Dowin</creator><creator>Anderson, Nientara</creator><creator>Kim, Jung G</creator><creator>Holmboe, Eric S</creator><creator>McDade, William A</creator><creator>Fancher, Tonya</creator><creator>Gross, Cary P</creator><creator>Chaudhry, Sarwat</creator><creator>Nguyen, Mytien</creator><creator>Nguemeni Tiako, Max Jordan</creator><creator>Colson, Eve</creator><creator>Xu, Yunshan</creator><creator>Li, Fangyong</creator><creator>Dziura, James D</creator><creator>Saha, Somnath</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20221201</creationdate><title>Racial and Ethnic Differences in Internal Medicine Residency Assessments</title><author>Boatright, Dowin ; Anderson, Nientara ; Kim, Jung G ; Holmboe, Eric S ; McDade, William A ; Fancher, Tonya ; Gross, Cary P ; Chaudhry, Sarwat ; Nguyen, Mytien ; Nguemeni Tiako, Max Jordan ; Colson, Eve ; Xu, Yunshan ; Li, Fangyong ; Dziura, James D ; Saha, Somnath</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a418t-29d3cf91c1fe883874a6613e93376cd107bb8ce486b47c27f89218b5d3438303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Cultural differences</topic><topic>Education, Medical, Graduate</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Hispanic people</topic><topic>Humans</topic><topic>Internal medicine</topic><topic>Internship and Residency</topic><topic>Male</topic><topic>Medical education</topic><topic>Medicine</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boatright, Dowin</creatorcontrib><creatorcontrib>Anderson, Nientara</creatorcontrib><creatorcontrib>Kim, Jung G</creatorcontrib><creatorcontrib>Holmboe, Eric S</creatorcontrib><creatorcontrib>McDade, William A</creatorcontrib><creatorcontrib>Fancher, Tonya</creatorcontrib><creatorcontrib>Gross, Cary P</creatorcontrib><creatorcontrib>Chaudhry, Sarwat</creatorcontrib><creatorcontrib>Nguyen, Mytien</creatorcontrib><creatorcontrib>Nguemeni Tiako, Max Jordan</creatorcontrib><creatorcontrib>Colson, Eve</creatorcontrib><creatorcontrib>Xu, Yunshan</creatorcontrib><creatorcontrib>Li, Fangyong</creatorcontrib><creatorcontrib>Dziura, James D</creatorcontrib><creatorcontrib>Saha, Somnath</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boatright, Dowin</au><au>Anderson, Nientara</au><au>Kim, Jung G</au><au>Holmboe, Eric S</au><au>McDade, William A</au><au>Fancher, Tonya</au><au>Gross, Cary P</au><au>Chaudhry, Sarwat</au><au>Nguyen, Mytien</au><au>Nguemeni Tiako, Max Jordan</au><au>Colson, Eve</au><au>Xu, Yunshan</au><au>Li, Fangyong</au><au>Dziura, James D</au><au>Saha, Somnath</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial and Ethnic Differences in Internal Medicine Residency Assessments</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>5</volume><issue>12</issue><spage>e2247649</spage><epage>e2247649</epage><pages>e2247649-e2247649</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education.
To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents.
This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022.
The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes.
The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P < .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P < .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P < .001). By the final year 3 assessment, the gap between White and Asian and URiM residents' scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training.
In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>36580337</pmid><doi>10.1001/jamanetworkopen.2022.47649</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2574-3805 |
| ispartof | JAMA network open, 2022-12, Vol.5 (12), p.e2247649-e2247649 |
| issn | 2574-3805 2574-3805 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2759264421 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Cohort analysis Cohort Studies Cultural differences Education, Medical, Graduate Ethnicity Female Hispanic people Humans Internal medicine Internship and Residency Male Medical education Medicine Retrospective Studies |
| title | Racial and Ethnic Differences in Internal Medicine Residency Assessments |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T16%3A53%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Racial%20and%20Ethnic%20Differences%20in%20Internal%20Medicine%20Residency%20Assessments&rft.jtitle=JAMA%20network%20open&rft.au=Boatright,%20Dowin&rft.date=2022-12-01&rft.volume=5&rft.issue=12&rft.spage=e2247649&rft.epage=e2247649&rft.pages=e2247649-e2247649&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2022.47649&rft_dat=%3Cproquest_cross%3E2759217723%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2759217723&rft_id=info:pmid/36580337&rfr_iscdi=true |