Cross-sectional study of obstetrics and gynecology-bound students in visiting rotations

Cross-sectional study of obstetrics and gynecology-bound students in visiting rotations | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cross-sectional study of obstetrics and gynecology-bound students in visiting rotations Melody Y. Hou, Tiffany M. Hodgens, Mytien Nguyen, Marjorie J. Westervelt, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5611705/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted 8 You are reading this latest preprint version Abstract Background Recruitment of a more diverse obstetrics and gynecology workforce may help improve patient outcomes, particularly among women of color. Visiting rotations play a role in competing for a position in an obstetrics and gynecology residency, however, not all students may be able to complete these expensive experiences. Our objective was to evaluate socioeconomic and other demographic differences among obstetrics and gynecology-bound students who participate in visiting rotations versus those who do not. Methods We obtained de-identified data from the Association of American Medical Colleges for students graduating in US allopathic medical schools 2019 or 2020. We analyzed self-reported receipt of state and/or federal assistance to obtain postsecondary education, medical education debt, sex, and race and ethnicity data using chi-square and ANOVA analyses and logistic regression. Results Of 33,287 graduating medical students, 1978 (5.9%) indicated “Obstetrics and Gynecology” as their intended practice and included socio-demographic data; 1110 (56.1%) of these completed at least one visiting rotation. In multivariable analysis including medical education debt, race and ethnicity, and sex, students with moderate debt were less likely to complete any visiting rotation (aOR 0.68, 95% CI: 0.52, 0.89) and students with any debt were less likely to complete two or more visiting rotations than those without debt. However, Black students were significantly more likely to complete two or more rotations than white students when adjusted for debt and sex (aOR 1.48, 95% CI: 1.02, 2.11). Conclusions Among obstetrics and gynecology-bound medical students, moderate medical education debt was associated with lower odds of completing visiting rotations when adjusted for race and ethnicity and sex. However, when adjusted for sex and debt, Black students were more likely to complete two or more visiting rotations than white students. undergraduate medical education obstetrics and gynecology recruitment medical students away audition debt race and ethnicity Figures Figure 1 Background Health outcomes improve with racial concordance between patient and physician,( 1 , 2 ) but physician racial and ethnic diversity does not reflect that of the general U.S. population.( 3 , 4 ) To improve this gap, many U.S. healthcare systems and medical schools have focused on recruiting a more diverse workforce,( 5 – 7 ) yet in obstetrics and gynecology (OBGYN), the proportion of Black OBGYN residents has decreased from 2014 to 2019, with Black and Hispanic residents comprising 9.5% and 10.5% of OBGYN residents, respectively, and other specialties have not fared much better.( 4 ) In the US, a student who completes medical school must enter a postgraduate training program, also known as a residency, to complete their training as a physician. The residency match process involves both applicants and residency programs submitting ranked preference lists that ultimately results in the placement (or non-placement) of an applicant in a residency program.( 8 ) Many residency program directors cite visiting rotations, also known as away or audition rotations, as one of the most influential factors for granting applicants interviews and determining their rank list in the National Resident Matching Program (NRMP).( 9 ) A visiting rotation is a clinical elective rotation at a different institution outside of a student’s home medical school, which potentially increases the likelihood of a student matching with the program or within the specialty.( 10 ) Medical students recognize this impact of visiting rotations,( 11 ) such that students feel obligated to complete visiting rotations to increase their chances of matching into competitive specialties.( 12 – 14 ) However, 35% of US medical students are unable to participate in visiting rotations due to financial constraints, affecting low-income students and possibly racially and ethnically underrepresented in medicine (URiM) students who carry a disproportionate amount of debt.( 15 – 17 ) In OBGYN, about half of residency applicants complete visiting rotations, and understanding differences between OBGYN-bound students who pursue or do not pursue visiting rotation opportunities may provide insight into the disparities seen among OBGYN residents.( 4 , 18 , 19 ) Delineating these differences will be critical as the importance of a visiting rotation to match success may increase with the elimination of United States Medical Licensing Exam (USMLE) Step 1 exam numeric scores, more frequent use of pass/fail grading in required clinical clerkships, and the OBGYN specialty standards of both virtual residency interviews and application signaling.( 20 – 26 ) Our aim is to identify sex, racial and ethnic, and socioeconomic factors associated with completing visiting rotations among OBGYN-bound students. Methods We obtained a de-identified dataset from the Association of American Medical Colleges (AAMC), a national membership organization representing all US allopathic medical schools. The dataset included the 2019 or 2020 Graduation Questionnaire (GQ) responses from all graduating students,( 26 ) linked to student-level self-reported data from their American Medical College Application Service (AMCAS), Matriculating Student Questionnaire (MSQ), and Year 2 Questionnaire (Y2Q). Each year, the AAMC conducts these surveys of all medical students, of which only AMCAS is required. These national surveys are administered online via unique private links at the time of medical school application, during first year of medical school enrollment in June, at the beginning of second year of medical school October to January, and at the end of medical school from February to June, respectively, with student identification remaining anonymous to schools. We chose 2019 and 2020 as the final two years during which the OBGYN application process had been stable; in each year since, the OBGYN application process has been affected by responses to the coronavirus disease of 2019 (COVID-19) pandemic, US Medical Licensing Examination (USMLE) Step 1 score changes, and iterative changes prompted by the Association of Professors in Gynecology and Obstetrics’ “Transforming the UME to GME Transition: Right Resident, Right Program, Ready Day One” project.( 20 , 22 , 27 ) Students could choose among eight race and ethnicity categories: white, non-Hispanic American Indian/Alaska Native, non-Hispanic Asian, Black, Hispanic, non-Hispanic Native Hawaiian/Pacific Islander, Other, and Unknown, and could further specify with options within these categories although these were not available in the provided dataset. Due to small numbers in the data, we grouped students identifying as non-Hispanic American Indian/Alaska Native or non-Hispanic Native Hawaiian/Pacific Islander with Other. We assigned students who reported race and ethnicity in two or more of these groups as Multiracial. Students could disclose sex as male, female, or not disclose. Our three socioeconomic status indicators included two self-reported measures of financial assistance: receipt of Pell grant, which is a federal grant to support students obtaining postsecondary education who display exceptional financial need, and state or federal assistance, both obtained from the AMCAS survey. Our third socioeconomic indicator was self-reported medical education debt at graduation, categorized in quintiles from zero to > $ 250,000, which we labeled “no debt,” “low debt”, “moderate debt”, “high debt” and “extremely high debt.” We analyzed our outcomes using responses to the following questions on the GQ: “By the time you have graduated from medical school, will you have completed any away rotations? Include only rotations that were required by your medical school for graduation AND were at institutions not affiliated with your medical school.” and “How many away rotations will you have completed? Include only rotations that were not required by your medical school for graduation AND were at institutions not affiliated with your medical school.” We excluded students who did not indicate a specialty, and who did not indicate a number for visiting rotations completed. We analyzed missing data from the race and ethnicity, sex, and the medical education debt questions (Appendix A) for patterns of missingness using Little’s MCAR test which yielded a chi-square statistic of 4.25 (df = 3, p = 0.24). Since p > 0.05, we considered the data missing completely at random and removed them from the sample. We examined demographic and socioeconomic differences between students who indicated “Obstetrics and Gynecology” as their intended area of practice versus all other students. Among students who indicated “Obstetrics and Gynecology” as their intended care of practice, we compared demographics of students who did or did not complete visiting rotations using chi-square tests and ANOVA analyses. Since visiting OBGYN-bound students complete a median of one visiting rotation,( 19 ) we evaluated those who completed 2 or more visiting rotations to identify any additional associations with completing extra visiting rotations. Reference groups were selected based on assumptions of the group whose ability to complete a visiting rotation was least likely impacted by the selected variable. We used logistic regression models to determine the association between socioeconomic status, race and ethnicity, and sex with the number of visiting rotations. We used R, version 4.3.2 for all statistical analyses.( 28 ) A 2-sided p < 0.05 defined statistical significance. The University of California, Davis Health Institutional Review Board deemed this study not human subject research. Results The national response rate for the 2019 GQ and 2020 GQ was 83.6% and 81.6%, respectively, resulting in 33,287 responses. Students with missing data for specialty, visiting rotations, sex, medical education debt, or race and ethnicity were excluded from the analysis. Of the remaining 29,706 students, 1978/29,706 (6.6%) indicated “Obstetrics and Gynecology” as their intended area of practice. Students intending OBGYN compared to those students who indicated a different specialty were more likely to be female (1734/1978, 87.6% vs 13390/27,728, 48.3%), Black (176/1978, 8.9% vs 1484/27,728, 5.4%), Hispanic (131/1978, 6.6% vs 1467/27,728, 5.3%) and have medical education debt (1467/1978, 74.2% vs 19464/27,728, 70.2%). They were also less likely to be Asian (297/1978, 15.0% vs 5997/27,728, 21.6%) (Table 1 ). Among OBGYN-bound students, the distribution of debt level varied significantly between race and ethnicity groups (Table 2 ). Table 1 Demographics of and number of visiting rotations completed by students who intended to practice Obstetrics and Gynecology compared to all other students who completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020. Variable N Overall Ob/Gyn Other Specialties p-value 2 N = 29,706 1 N = 1,978 1 N = 27,728 1 Sex 29,706 < 0.001 Male 14,582 (49.1%) 244 (12.3%) 14,338 (51.7%) Female 15,124 (50.9%) 1,734 (87.7%) 13,390 (48.3%) Race/Ethnicity 3 29,706 < 0.001 White 17,102 (57.6%) 1,151 (58.2%) 15,951 (57.5%) Asian 6,294 (21.2%) 297 (15.0%) 5,997 (21.6%) Black 1,660 (5.6%) 176 (8.9%) 1,484 (5.4%) Hispanic 1,598 (5.4%) 131 (6.6%) 1,467 (5.3%) Multiracial 2,458 (8.3%) 186 (9.4%) 2,272 (8.2%) Other 594 (2.0%) 37 (1.9%) 557 (2.0%) Socioeconomic Status Indicators Received Pell Grant 4 27,118 5,940 (21.9%) 382 (20.5%) 5,558 (22.0%) 0.14 Received State/Fed Assistance 25,897 3,006 (10.6%) 215 (11.2%) 2,791 (10.5%) 0.26 Medical Education Debt 5 29,706 0.006 No debt ( $ 0) 8,775 (29.5%) 511 (25.8%) 8,264 (29.8%) Low ( $ 1- $ 110,000) 4,037 (13.6%) 290 (14.7%) 3,747 (13.5%) Moderate ( $ 110,001- $ 190,000) 5,789 (19.5%) 399 (20.2%) 5,390 (19.4%) High (190,001- $ 250,000) 6,299 (21.2%) 445 (22.5%) 5,854 (21.1%) Extremely high (> $ 250,000) 4,806 (16.2%) 333 (16.8%) 4,473 (16.1%) Number of Visiting Rotations 29,706 < 0.001 No Visiting Rotations 13,362 (45.0%) 868 (43.9%) 12,494 (45.1%) 1 Visiting Rotation 6,480 (21.8%) 640 (32.4%) 5,840 (21.1%) 2 Visiting Rotations 5,925 (19.9%) 340 (17.2%) 5,585 (20.1%) 3 Visiting Rotations 2,941 (9.9%) 99 (5.0%) 2,842 (10.2%) 4 + Visiting Rotations 998 (3.4%) 31 (1.6%) 967 (3.5%) 1 n (%); Mean (SD) 2 Pearson’s Chi-squared test; Wilcoxon rank sum test 3 Due to low numbers in the cohort, students identifying as American Indian/Alaska Native or Native Hawaiian/Pacific Islander were grouped with Other race and ethnicity, and multiracial students are shown in aggregate. 4 Federal grant supporting students obtaining postsecondary education who display exceptional financial need 5 Self-reported amount owed on medical education loans. Table 2 Distribution of medical education debt by race and ethnicity of students who intended to practice Obstetrics and Gynecology and completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020. Variable White Asian Black Hispanic Multiracial Other Unadjusted p-value 2 N = 1,978 N = 1,151 1 N = 297 1 N = 176 1 N = 131 1 N = 186 1 N = 37 1 Med. Ed. Debt < 0.001 No Debt 290 (25.2%) 114 (38.4%) 19 (10.8%) 29 (22.1%) 46 (24.7%) 13 (35.1%) Low ( $ 1- $ 110,000) 149 (12.9%) 54 (18.2%) 26 (14.8%) 24 (18.3%) 32 (17.2%) 5 (13.5%) Moderate ( $ 110,001- $ 190,000) 227 (19.7%) 52 (17.5%) 39 (22.2%) 33 (25.2%) 44 (23.7%) 4 (10.8%) High (190,001- $ 250,000) 271 (23.5%) 46 (15.5%) 56 (31.8%) 29 (22.1%) 34 (18.3%) 9 (24.3%) Extremely High (> $ 250,000) 214 (18.6%) 31 (10.4%) 36 (20.5%) 16 (12.2%) 30 (16.1%) 6 (16.2%) Of the students who indicated OBGYN, 1110/1978 (56.1%) completed at least one visiting rotation (Table 1 ). The demographic and socioeconomic comparison of these students with those visiting students in other specialties mirrored our previous comparison of all OBGYN-bound students versus all non-OBGYN-bound students in terms of sex and race and ethnicity, although medical education debt was not significantly different between groups of visiting students (data not shown). In univariate analyses of OBGYN-bound students (Table 3 ), we found a significant relationship between visiting rotations completed and debt level quintiles (p = 0.04). We found no significant difference in Pell grant or state and/or federal assistance receipt between those who completed visiting rotations and those who did not (p = 0.62 and 0.35, respectively). Since Pell grant and state and/or federal assistance receipt strongly correlated with medical education debt, we included medical education debt quintiles as our socioeconomic indicator for all multivariable analyses. We chose to keep sex and race and ethnicity as covariates given our aims. Table 3 Demographics of students who completed a visiting rotation versus those who did not, among students who intend to practice Obstetrics and Gynecology and completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020. Variable N No Visiting Rotations Any (1+) Visiting Rotations Unadjusted p-value 2 N = 868 1 N = 1,110 1 Sex 1,978 0.06 Male 121 (13.9%) 123 (11.1%) Female 747 (86.1%) 987 (88.9%) Race/Ethnicity 3 1,978 0.59 White 521 (60.0%) 630 (56.8%) Asian 118 (13.6%) 179 (16.1%) Black 76 (8.8%) 100 (9.0%) Hispanic 53 (6.1%) 78 (7.0%) Multiracial 83 (9.6%) 103 (9.3%) Other 17 (2.0%) 20 (1.8%) Socioeconomic Status Indicators Received Pell Grant 4 1,860 171 (21.0%) 211 (20.2%) 0.68 Received State/Fed Assistance 1,780 160 (20.6%) 192 (19.2%) 0.50 Medical Education Debt 5 1,978 0.04 No debt ( $ 0) 204 (23.5%) 307 (27.7%) Low ( $ 1-110,000) 133 (15.3%) 157 (14.1%) Moderate ( $ 110,001-190,000) 198 (22.8%) 201 (18.1%) High ( $ 190,001-250,000) 196 (22.6%) 249 (22.4%) Extremely high (> $ 250,000) 137 (15.8%) 196 (17.7%) 1 n (%); Mean (SD) 2 Pearson’s Chi-squared test 3 Due to low numbers in the cohort, students identifying as American Indian/Alaska Native or Native Hawaiian/Pacific Islander were grouped with Other race and ethnicity, and multiracial students are shown in aggregate. 4 Federal grant to support students obtaining postsecondary education who display exceptional financial need 5 Self-reported amount owed on medical education loans. In multivariable logistic regressions using medical education debt quintiles, race and ethnicity, and sex, having moderate debt was associated with lower odds of completing any visiting rotation (aOR 0.68, 95% CI: 0.52, 0.89; p = 0.01), and any (non-zero) medical education debt was associated with lower odds of completing two or more visiting rotations (all with p < 0.002) (Fig. 1 ). However, when adjusted for debt and sex, Black students were significantly more likely to complete two or more visiting rotations than white students (aOR 1.48, 95% CI: 1.02, 2.11; p = 0.03). Discussion Visiting rotations are considered to have significant influence in the competitive process of matching into a US residency.( 9 ) In 2023 dollars, the mean estimated cost for a single visiting rotation is $ 1240 exclusive of the cost of maintaining a primary residence.( 29 , 30 ) More than half (56%) of U.S. OBGYN residency applicants in our study completed visiting rotations, of which 42.3% completed two or more. We found that OBGYN-bound medical students with moderate levels of medical education debt ( $ 110,001 to 190,000) were less likely to complete one or more visiting rotations. When adjusted for race and ethnicity and sex, students with non-zero medical education debt were less likely to complete two or more visiting rotations. When we adjusted for medical education debt and sex, Black students were significantly more likely to complete two or more rotations than white students. Residency programs can take several actions in response to these findings. Programs should offer more clarity regarding the impact of visiting rotations on an applicant’s interview invitation and matching chances, as the Coalition for Physician Accountability has called for transparency from residency programs about how visiting rotations are used for interview and resident selection.( 31 , 32 ) Although the OBGYN specialty has committed to virtual residency interviews to help mitigate financial inequities among students,( 22 ) no such commitment has been made regarding visiting rotations. The scant existing scholarships offered to low-income students to complete rotations may become even more limited in the current political climate in the US.( 33 ) Expanding the number of schools offering need-based debt-free medical education or short term zero-interest loans may remain aspirational goals.( 34 ) Our findings indicate additional complexity beyond individual program accountability and student debt. Although we demonstrated a clear association between any level of medical education debt and not completing two or more visiting rotations, the relationship between debt and odds of completing any visiting rotation was not linear and will require additional research. In our study, Black students were more likely to complete two or more visiting rotations compared to their white counterparts, when adjusted for levels of debt. This may be driven by students with limited professional networks( 35 ) who complete visiting rotations for a better opportunity to assess potential residency programs rather than relying on programs’ online self-portrayal.( 11 ) However, this difference may instead reflect students completing visiting rotations in an attempt to increase their chance of successful match.( 9 ) Other research demonstrates that URiM students have lower rates of transition into graduate medical education,( 18 ) and that these students already bear a disproportionate amount of debt.( 16 , 17 ) URiM students with debt may exacerbate their debt by completing more visiting rotations which ultimately may not improve their match success: despite visiting rotations being influential, only 34.7% of OBGYN program directors guarantee an interview to students on a visiting rotation and less than 25% of residents in most OBGYN residencies completed a visiting student rotation with their program.( 32 ) We are also concerned that URiM students with debt who are advised to complete more visiting rotations to improve their chances of matching in OBGYN may decide not to apply to the specialty due to the considerable financial investment required, although these hypotheses require additional investigation.( 18 , 36 ) Individual programs instead can strengthen their mission-based holistic reviews of applications, which is a foundational strategy to promoting diversity, equity, and inclusion in residency,( 37 ) and deemphasize the weight of the visiting rotation in the application process. The OBGYN specialty society can create residency program partnerships with Historically Black Colleges and Universities (HBCUs) and other Minority Serving Institutions to improve networking opportunities for those students( 35 , 38 , 39 ) and consider instituting a cap on the number of visiting rotations a student can complete. Ensuring equitable opportunities to all students throughout medical school,( 37 ) including visiting rotations, is critical for recruitment of diverse students. Our study has several limitations. Our cross-sectional study is only able to establish associations with visiting rotation completion but not causality, and these self-reported data are subject to response bias. We excluded students with missing data, although data appeared to be missing at random, and we were not powered to draw conclusions for the “other” group in race and ethnicity analyses. We also lack student performance metrics, such as grades and USMLE Step scores, geographic location, and evidence of financial or cultural institutional support, which may influence the decision to participate in visiting rotations. Finally, these data are not linked to students’ actual match outcomes, data which are owned by the NRMP, an independent organization not associated with AAMC. Our findings with 2 years of data are insufficient to establish a trend, and may not be generalizable to current practices, since the visiting rotation moratorium in academic year 2020-21 due to COVID-19,( 27 ) the limit of one visiting rotation per student in the following academic year 2021-22, USMLE Step 1 now graded as pass or fail,( 20 ) more medical schools moving to pass/fail clerkship grading,( 21 ) and virtual residency interviews( 22 ) may have other effects on the perceived value of visiting rotations. Since the latter three issues may lead to challenges with applicant evaluation and differentiation for residency programs,( 24 , 25 , 40 ) program directors may place even more weight on visiting rotations. Our study thus plays a critical role by identifying disparities in medical education debt and race and ethnicity in visiting rotation completion, which may be exacerbated if program directors increase the emphasis on visiting rotations. Conclusions Among obstetrics and gynecology-bound medical students, moderate medical education debt was associated with lower odds of completing visiting rotations pre-COVID-19, with non-zero debt associated with lower odds of completing 2 or more visiting rotations compared with students with no debt. However, Black students were more likely to complete two or more visiting rotations than white students, adjusted for debt and sex. The post-pandemic changes to the OBGYN application process, including Step 1 and clerkship grade changes and virtual interviews, may increase the importance of visiting rotations and further exacerbate these disparities despite our efforts to diversify our workforce. As matching into the specialty becomes more competitive, either providing more financial support or conscientiously deemphasizing or capping the visiting rotation as part of the application will be critical in our goal for parity. Abbreviations OBGYN, obstetrics and gynecology NRMP, National Resident Matching Program URiM, underrepresented in medicine AAMC, Association of American Medical Colleges GQ, Graduation Questionnaire AMCAS, American Medical College Application Service MSQ, Matriculating Student Questionnaire Y2Q, Year 2 Questionnaire Coronavirus disease of 2019, COVD-19 USMLE, US Medical Licensing Exam Declarations Ethics approval and consent to participate: This study was deemed not human subject research by the University of California, Davis Health Institutional Review Board, and consent was deemed unnecessary (Reference number 1780782-1). Consent for publication: Not applicable Availability of data and materials: The data that support the findings of this study are available from the Association of American Medical Colleges (AAMC) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Competing interests: The authors report no conflict of interest. Funding: Funding for AAMC data requisition provided by the Office of Student and Resident Diversity, University of California, Davis School of Medicine. Authors’ contributions: MYH conceived of the project, with input from TMH, MN, MJW, DB, CLL and TLF on study design. TMH analyzed the data, interpreted by MYH, TMH, MN, MJW, MAT, DB, CLL and TLF. MYH wrote the main manuscript and TMH prepared figure 1, with revisions from MYH, TMH, MN, MJW, MAT, DB, CLL and TLF. All authors reviewed the manuscript. Acknowledgements: Not applicable Presented in part as poster abstracts at American Congress of Obstetricians and Gynecologists District IX Annual Meeting December 2022 and Council on Resident Education in Obstetrics and Gynecology and Association of Professors in Gynecology and Obstetrics Annual Meeting March 2023. References Greenwood BN, Hardeman RR, Huang L, Sojourner A. 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Available from: https://www.R-project.org/ Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016 Nov 14;16(1):291. U.S. Bureau of Labor Statistics. CPI Inflation Calculator [Internet]. Washington, D.C.: United States Department of Labor; [cited 2024 Jan 19]. Available from: https://www.bls.gov/data/inflation_calculator.htm The Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC): Recommendations for comprehensive improvement of the UME-GME transition [Internet]. Washington, D.C.: Coalition for Physician Accountability; 2021 Aug [cited 2023 Jul 12]. Available from: https://physicianaccountability.org/wp-content/uploads/2021/08/UGRC-Coalition-Report-FINAL.pdf George KE, Litman EA, Banks E, Morgan HK, Hammoud MM, Strand E. Away rotations in obstetrics and gynecology: a survey of program directors. J Surg Educ. 2023 Sep;80(9):1340–9. The White House [Internet]. 2025 [cited 2025 Mar 17]. Ending radical and wasteful government DEI programs and preferencing. Available from: https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-and-wasteful-government-dei-programs-and-preferencing/ Pisaniello MS, Asahina AT, Bacchi S, Wagner M, Perry SW, Wong ML, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open. 2019 Jul 2;9(7):e029980. Norris KC, Baker RS, Taylor R, Montgomery-Rice V, Higginbotham EJ, Riley WJ, et al. Historically black medical schools: addressing the minority health professional pipeline and the public mission of care for vulnerable populations. J Natl Med Assoc. 2009 Sep;101(9):864–72. Sondheimer HM, Xierali IM, Young GH, Nivet MA. Placement of US medical school graduates into graduate medical education, 2005 through 2015. JAMA. 2015 Dec 8;314(22):2409–10. Boatright D, London M, Soriano AJ, Westervelt M, Sanchez S, Gonzalo JD, et al. Strategies and best practices to improve diversity, equity, and inclusion among US graduate medical education programs. JAMA Netw Open. 2023 Feb 1;6(2):e2255110. Weiss J, Nguementi Tiako MJ, Akingbesote ND, Keene D, Balasuriya L, Sharifi M, et al. Perspectives on medical school admission for Black students among premedical advisers at Historically Black Colleges and Universities. JAMA Netw Open. 2024 Oct 1;7(10):e2440887. Nguyen M, Sutton EH, Mason HRC. HBCUs are an undervalued resource for addressing the US physician shortage. JAMA Netw Open. 2024 Oct 23;7(10):e2440966. National Resident Matching Program. Results and data: 2024 main residency match. Washington DC: National Residency Matching Program; 2024. Additional Declarations No competing interests reported. Supplementary Files OBGVLSOBMCMedEdAppendixA.docx Cite Share Download PDF Status: Published Journal Publication published 29 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 09 May, 2025 Reviews received at journal 28 Apr, 2025 Reviews received at journal 23 Apr, 2025 Reviewers agreed at journal 22 Apr, 2025 Reviewers agreed at journal 06 Apr, 2025 Reviewers invited by journal 03 Apr, 2025 Submission checks completed at journal 02 Apr, 2025 First submitted to journal 25 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5611705","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":438016842,"identity":"6abba402-d97b-4f46-9b54-61a07c11d685","order_by":0,"name":"Melody Y. Hou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYFACHiCuAOIDYMTA2ECcljMka2Fsg2hhIEqL7ozcg4955x2W5zt+xvDgDwYb2Q0HCGgxu5GXbMy77bDhzDM5Bod5GNKMidCSYyYN1JJgcCAt4TADw+FEIrXMAWo5/ywB6LD/xGppAGq5kXzgAA/DASK0nHljbDjnWLrhzBuPDxzmMUg2nklQy/Ecwwdvaqzl+c4nNn/8UWEn20dIC4NAAjLPgJByEOAnaOgoGAWjYBSMeAAAvH9LdjCeuAAAAAAASUVORK5CYII=","orcid":"","institution":"University of California, Davis School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Melody","middleName":"Y.","lastName":"Hou","suffix":""},{"id":438016843,"identity":"84254890-938a-4b2f-87bf-05d69fd33705","order_by":1,"name":"Tiffany M. Hodgens","email":"","orcid":"","institution":"University of California, Davis School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tiffany","middleName":"M.","lastName":"Hodgens","suffix":""},{"id":438016844,"identity":"03d2aa3d-c0e0-4309-b0a4-fb8139bca79f","order_by":2,"name":"Mytien Nguyen","email":"","orcid":"","institution":"Yale School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mytien","middleName":"","lastName":"Nguyen","suffix":""},{"id":438016845,"identity":"7f15794d-8d6b-4331-aa00-27267cc852d4","order_by":3,"name":"Marjorie J. Westervelt","email":"","orcid":"","institution":"University of California, Davis School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Marjorie","middleName":"J.","lastName":"Westervelt","suffix":""},{"id":438016846,"identity":"3f1fd68b-517a-4322-9746-5d7ba9d1323d","order_by":4,"name":"Melissa A. Toland","email":"","orcid":"","institution":"University of California, Davis School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Melissa","middleName":"A.","lastName":"Toland","suffix":""},{"id":438016847,"identity":"59aa2290-2035-4b3b-b46d-cb1e7ade706f","order_by":5,"name":"Dowin Boatright","email":"","orcid":"","institution":"New York University Grossman School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Dowin","middleName":"","lastName":"Boatright","suffix":""},{"id":438016848,"identity":"cefae9d3-a687-4c87-8657-5d8356e482ef","order_by":6,"name":"Claudia L. Lopez","email":"","orcid":"","institution":"University of California, Davis School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"L.","lastName":"Lopez","suffix":""},{"id":438016849,"identity":"bb24cf15-b57f-477b-bdbb-718d8357222f","order_by":7,"name":"Tonya L. Fancher","email":"","orcid":"","institution":"University of California, Davis School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tonya","middleName":"L.","lastName":"Fancher","suffix":""}],"badges":[],"createdAt":"2024-12-09 21:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5611705/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5611705/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-07690-x","type":"published","date":"2025-07-29T16:21:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79905740,"identity":"6b8c11f6-b11d-44be-b0f0-cae3878af567","added_by":"auto","created_at":"2025-04-04 10:58:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64849,"visible":true,"origin":"","legend":"\u003cp\u003eAssociations with the number of visiting rotations completed among medical students who completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020 who intended to practice Obstetrics and Gynecology. (A) Distribution of visiting rotations (light blue = none, medium blue = 1, dark blue = 2 or more) by medical education debt quintile, race and ethnicity, and sex; medical education debt quintile definitions: no debt, $0; low, $1-110,000; moderate, $110,001-190,000; high, $190,001-250,000; extremely high, \u0026gt;$250,000 (B) Adjusted odds ratios of completing any visiting rotation or (C) two or more visiting rotations, by medical education debt quintile, race and ethnicity, and sex, using white males with no medical education debt as the reference group. Due to low numbers in the cohort, students identifying as American Indian/Alaska Native or Native Hawaiian/Pacific Islander were grouped with Other race and ethnicity, and multiracial students are shown in aggregate. Medical Ed Debt, medical education debt is self-reported amount owed on medical education loans.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5611705/v1/e389669f1b35f094edbb257b.png"},{"id":88268216,"identity":"159a95be-6bf2-4e32-a7ea-b0289726e895","added_by":"auto","created_at":"2025-08-04 16:50:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":856911,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5611705/v1/0da9bd9a-75f6-4432-8340-57f310ac08db.pdf"},{"id":79906313,"identity":"93f4f2d8-c811-4860-a718-def127b31585","added_by":"auto","created_at":"2025-04-04 11:06:30","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18709,"visible":true,"origin":"","legend":"","description":"","filename":"OBGVLSOBMCMedEdAppendixA.docx","url":"https://assets-eu.researchsquare.com/files/rs-5611705/v1/97bdea16f8b93e3c960aba29.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cross-sectional study of obstetrics and gynecology-bound students in visiting rotations","fulltext":[{"header":"Background","content":"\u003cp\u003eHealth outcomes improve with racial concordance between patient and physician,(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) but physician racial and ethnic diversity does not reflect that of the general U.S. population.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) To improve this gap, many U.S. healthcare systems and medical schools have focused on recruiting a more diverse workforce,(\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) yet in obstetrics and gynecology (OBGYN), the proportion of Black OBGYN residents has decreased from 2014 to 2019, with Black and Hispanic residents comprising 9.5% and 10.5% of OBGYN residents, respectively, and other specialties have not fared much better.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn the US, a student who completes medical school must enter a postgraduate training program, also known as a residency, to complete their training as a physician. The residency match process involves both applicants and residency programs submitting ranked preference lists that ultimately results in the placement (or non-placement) of an applicant in a residency program.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Many residency program directors cite visiting rotations, also known as away or audition rotations, as one of the most influential factors for granting applicants interviews and determining their rank list in the National Resident Matching Program (NRMP).(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) A visiting rotation is a clinical elective rotation at a different institution outside of a student\u0026rsquo;s home medical school, which potentially increases the likelihood of a student matching with the program or within the specialty.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Medical students recognize this impact of visiting rotations,(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) such that students feel obligated to complete visiting rotations to increase their chances of matching into competitive specialties.(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) However, 35% of US medical students are unable to participate in visiting rotations due to financial constraints, affecting low-income students and possibly racially and ethnically underrepresented in medicine (URiM) students who carry a disproportionate amount of debt.(\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) In OBGYN, about half of residency applicants complete visiting rotations, and understanding differences between OBGYN-bound students who pursue or do not pursue visiting rotation opportunities may provide insight into the disparities seen among OBGYN residents.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Delineating these differences will be critical as the importance of a visiting rotation to match success may increase with the elimination of United States Medical Licensing Exam (USMLE) Step 1 exam numeric scores, more frequent use of pass/fail grading in required clinical clerkships, and the OBGYN specialty standards of both virtual residency interviews and application signaling.(\u003cspan additionalcitationids=\"CR21 CR22 CR23 CR24 CR25\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) Our aim is to identify sex, racial and ethnic, and socioeconomic factors associated with completing visiting rotations among OBGYN-bound students.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We obtained a de-identified dataset from the Association of American Medical Colleges (AAMC), a national membership organization representing all US allopathic medical schools. The dataset included the 2019 or 2020 Graduation Questionnaire (GQ) responses from all graduating students,(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) linked to student-level self-reported data from their American Medical College Application Service (AMCAS), Matriculating Student Questionnaire (MSQ), and Year 2 Questionnaire (Y2Q). Each year, the AAMC conducts these surveys of all medical students, of which only AMCAS is required. These national surveys are administered online via unique private links at the time of medical school application, during first year of medical school enrollment in June, at the beginning of second year of medical school October to January, and at the end of medical school from February to June, respectively, with student identification remaining anonymous to schools. We chose 2019 and 2020 as the final two years during which the OBGYN application process had been stable; in each year since, the OBGYN application process has been affected by responses to the coronavirus disease of 2019 (COVID-19) pandemic, US Medical Licensing Examination (USMLE) Step 1 score changes, and iterative changes prompted by the Association of Professors in Gynecology and Obstetrics\u0026rsquo; \u0026ldquo;Transforming the UME to GME Transition: Right Resident, Right Program, Ready Day One\u0026rdquo; project.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e Students could choose among eight race and ethnicity categories: white, non-Hispanic American Indian/Alaska Native, non-Hispanic Asian, Black, Hispanic, non-Hispanic Native Hawaiian/Pacific Islander, Other, and Unknown, and could further specify with options within these categories although these were not available in the provided dataset. Due to small numbers in the data, we grouped students identifying as non-Hispanic American Indian/Alaska Native or non-Hispanic Native Hawaiian/Pacific Islander with Other. We assigned students who reported race and ethnicity in two or more of these groups as Multiracial. Students could disclose sex as male, female, or not disclose. Our three socioeconomic status indicators included two self-reported measures of financial assistance: receipt of Pell grant, which is a federal grant to support students obtaining postsecondary education who display exceptional financial need, and state or federal assistance, both obtained from the AMCAS survey. Our third socioeconomic indicator was self-reported medical education debt at graduation, categorized in quintiles from zero to \u0026gt;\u003cspan\u003e$\u003c/span\u003e250,000, which we labeled \u0026ldquo;no debt,\u0026rdquo; \u0026ldquo;low debt\u0026rdquo;, \u0026ldquo;moderate debt\u0026rdquo;, \u0026ldquo;high debt\u0026rdquo; and \u0026ldquo;extremely high debt.\u0026rdquo; We analyzed our outcomes using responses to the following questions on the GQ: \u0026ldquo;By the time you have graduated from medical school, will you have completed any away rotations? Include only rotations that were required by your medical school for graduation AND were at institutions not affiliated with your medical school.\u0026rdquo; and \u0026ldquo;How many away rotations will you have completed? Include only rotations that were not required by your medical school for graduation AND were at institutions not affiliated with your medical school.\u0026rdquo; We excluded students who did not indicate a specialty, and who did not indicate a number for visiting rotations completed. We analyzed missing data from the race and ethnicity, sex, and the medical education debt questions (Appendix A) for patterns of missingness using Little\u0026rsquo;s MCAR test which yielded a chi-square statistic of 4.25 (df\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;=\u0026thinsp;0.24). Since p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, we considered the data missing completely at random and removed them from the sample.\u003c/p\u003e \u003cp\u003eWe examined demographic and socioeconomic differences between students who indicated \u0026ldquo;Obstetrics and Gynecology\u0026rdquo; as their intended area of practice versus all other students. Among students who indicated \u0026ldquo;Obstetrics and Gynecology\u0026rdquo; as their intended care of practice, we compared demographics of students who did or did not complete visiting rotations using chi-square tests and ANOVA analyses. Since visiting OBGYN-bound students complete a median of one visiting rotation,(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) we evaluated those who completed 2 or more visiting rotations to identify any additional associations with completing extra visiting rotations. Reference groups were selected based on assumptions of the group whose ability to complete a visiting rotation was least likely impacted by the selected variable. We used logistic regression models to determine the association between socioeconomic status, race and ethnicity, and sex with the number of visiting rotations. We used R, version 4.3.2 for all statistical analyses.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) A 2-sided p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 defined statistical significance.\u003c/p\u003e \u003cp\u003e The University of California, Davis Health Institutional Review Board deemed this study not human subject research.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe national response rate for the 2019 GQ and 2020 GQ was 83.6% and 81.6%, respectively, resulting in 33,287 responses. Students with missing data for specialty, visiting rotations, sex, medical education debt, or race and ethnicity were excluded from the analysis. Of the remaining 29,706 students, 1978/29,706 (6.6%) indicated \u0026ldquo;Obstetrics and Gynecology\u0026rdquo; as their intended area of practice. Students intending OBGYN compared to those students who indicated a different specialty were more likely to be female (1734/1978, 87.6% vs 13390/27,728, 48.3%), Black (176/1978, 8.9% vs 1484/27,728, 5.4%), Hispanic (131/1978, 6.6% vs 1467/27,728, 5.3%) and have medical education debt (1467/1978, 74.2% vs 19464/27,728, 70.2%). They were also less likely to be Asian (297/1978, 15.0% vs 5997/27,728, 21.6%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among OBGYN-bound students, the distribution of debt level varied significantly between race and ethnicity groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of and number of visiting rotations completed by students who intended to practice Obstetrics and Gynecology compared to all other students who completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOb/Gyn\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOther Specialties\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;29,706\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,978\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;27,728\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14,582 (49.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e244 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14,338 (51.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15,124 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,734 (87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13,390 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17,102 (57.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,151 (58.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15,951 (57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,294 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e297 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,997 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,660 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e176 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,484 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,598 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e131 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,467 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiracial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,458 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e186 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,272 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e594 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e557 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocioeconomic Status Indicators\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived Pell Grant\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27,118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,940 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e382 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,558 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived State/Fed Assistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25,897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,006 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e215 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,791 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Education Debt\u003c/b\u003e\u003csup\u003e\u003cb\u003e5\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo debt (\u003cspan\u003e$\u003c/span\u003e0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,775 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e511 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8,264 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (\u003cspan\u003e$\u003c/span\u003e1-\u003cspan\u003e$\u003c/span\u003e110,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,037 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e290 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3,747 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (\u003cspan\u003e$\u003c/span\u003e110,001-\u003cspan\u003e$\u003c/span\u003e190,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,789 (19.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e399 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,390 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (190,001-\u003cspan\u003e$\u003c/span\u003e250,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,299 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e445 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,854 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtremely high (\u0026gt;\u003cspan\u003e$\u003c/span\u003e250,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,806 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e333 (16.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4,473 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Visiting Rotations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo Visiting Rotations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13,362 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e868 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12,494 (45.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 Visiting Rotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,480 (21.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e640 (32.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,840 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 Visiting Rotations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,925 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e340 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,585 (20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 Visiting Rotations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,941 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,842 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026thinsp;+\u0026thinsp;Visiting Rotations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e998 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e967 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e1\u003c/sup\u003e n (%); Mean (SD)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e2\u003c/sup\u003e Pearson\u0026rsquo;s Chi-squared test; Wilcoxon rank sum test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e3\u003c/sup\u003e Due to low numbers in the cohort, students identifying as American Indian/Alaska Native or Native Hawaiian/Pacific Islander were grouped with Other race and ethnicity, and multiracial students are shown in aggregate.\u003c/p\u003e \u003cp\u003e \u003csup\u003e4\u003c/sup\u003e Federal grant supporting students obtaining postsecondary education who display exceptional financial need\u003c/p\u003e \u003cp\u003e \u003csup\u003e5\u003c/sup\u003e Self-reported amount owed on medical education loans.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of medical education debt by race and ethnicity of students who intended to practice Obstetrics and Gynecology and completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMultiracial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUnadjusted p-value\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,151\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;297\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;176\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;131\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;186\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;37\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMed. Ed. Debt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Debt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e290 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (38.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (\u003cspan\u003e$\u003c/span\u003e1-\u003cspan\u003e$\u003c/span\u003e110,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (\u003cspan\u003e$\u003c/span\u003e110,001-\u003cspan\u003e$\u003c/span\u003e190,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e227 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (190,001-\u003cspan\u003e$\u003c/span\u003e250,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e271 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (18.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtremely High (\u0026gt; \u003cspan\u003e$\u003c/span\u003e250,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e214 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOf the students who indicated OBGYN, 1110/1978 (56.1%) completed at least one visiting rotation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The demographic and socioeconomic comparison of these students with those visiting students in other specialties mirrored our previous comparison of all OBGYN-bound students versus all non-OBGYN-bound students in terms of sex and race and ethnicity, although medical education debt was not significantly different between groups of visiting students (data not shown).\u003c/p\u003e \u003cp\u003eIn univariate analyses of OBGYN-bound students (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), we found a significant relationship between visiting rotations completed and debt level quintiles (p\u0026thinsp;=\u0026thinsp;0.04). We found no significant difference in Pell grant or state and/or federal assistance receipt between those who completed visiting rotations and those who did not (p\u0026thinsp;=\u0026thinsp;0.62 and 0.35, respectively). Since Pell grant and state and/or federal assistance receipt strongly correlated with medical education debt, we included medical education debt quintiles as our socioeconomic indicator for all multivariable analyses. We chose to keep sex and race and ethnicity as covariates given our aims.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of students who completed a visiting rotation versus those who did not, among students who intend to practice Obstetrics and Gynecology and completed the Association of American Medical Colleges Graduation Questionnaire in 2019 or 2020.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo Visiting Rotations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAny (1+) Visiting Rotations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eUnadjusted p-value\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;868\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,110\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e123 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e747 (86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e987 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e521 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e630 (56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e179 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiracial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e103 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocioeconomic Status Indicators\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived Pell Grant\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e211 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived State/Fed Assistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e192 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical Education Debt\u003c/b\u003e\u003csup\u003e\u003cb\u003e5\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo debt (\u003cspan\u003e$\u003c/span\u003e0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e307 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (\u003cspan\u003e$\u003c/span\u003e1-110,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e157 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (\u003cspan\u003e$\u003c/span\u003e110,001-190,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e201 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (\u003cspan\u003e$\u003c/span\u003e190,001-250,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196 (22.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e249 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtremely high (\u0026gt;\u003cspan\u003e$\u003c/span\u003e250,000)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e196 (17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e1\u003c/sup\u003e n (%); Mean (SD)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e2\u003c/sup\u003e Pearson\u0026rsquo;s Chi-squared test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e3\u003c/sup\u003e Due to low numbers in the cohort, students identifying as American Indian/Alaska Native or Native Hawaiian/Pacific Islander were grouped with Other race and ethnicity, and multiracial students are shown in aggregate.\u003c/p\u003e \u003cp\u003e \u003csup\u003e4\u003c/sup\u003e Federal grant to support students obtaining postsecondary education who display exceptional financial need\u003c/p\u003e \u003cp\u003e \u003csup\u003e5\u003c/sup\u003e Self-reported amount owed on medical education loans.\u003c/p\u003e \u003cp\u003eIn multivariable logistic regressions using medical education debt quintiles, race and ethnicity, and sex, having moderate debt was associated with lower odds of completing any visiting rotation (aOR 0.68, 95% CI: 0.52, 0.89; p\u0026thinsp;=\u0026thinsp;0.01), and any (non-zero) medical education debt was associated with lower odds of completing two or more visiting rotations (all with p\u0026thinsp;\u0026lt;\u0026thinsp;0.002) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, when adjusted for debt and sex, Black students were significantly more likely to complete two or more visiting rotations than white students (aOR 1.48, 95% CI: 1.02, 2.11; p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eVisiting rotations are considered to have significant influence in the competitive process of matching into a US residency.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) In 2023 dollars, the mean estimated cost for a single visiting rotation is \u003cspan\u003e$\u003c/span\u003e1240 exclusive of the cost of maintaining a primary residence.(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) More than half (56%) of U.S. OBGYN residency applicants in our study completed visiting rotations, of which 42.3% completed two or more. We found that OBGYN-bound medical students with moderate levels of medical education debt (\u003cspan\u003e$\u003c/span\u003e110,001 to 190,000) were less likely to complete one or more visiting rotations. When adjusted for race and ethnicity and sex, students with non-zero medical education debt were less likely to complete two or more visiting rotations. When we adjusted for medical education debt and sex, Black students were significantly more likely to complete two or more rotations than white students.\u003c/p\u003e \u003cp\u003eResidency programs can take several actions in response to these findings. Programs should offer more clarity regarding the impact of visiting rotations on an applicant\u0026rsquo;s interview invitation and matching chances, as the Coalition for Physician Accountability has called for transparency from residency programs about how visiting rotations are used for interview and resident selection.(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) Although the OBGYN specialty has committed to virtual residency interviews to help mitigate financial inequities among students,(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) no such commitment has been made regarding visiting rotations. The scant existing scholarships offered to low-income students to complete rotations may become even more limited in the current political climate in the US.(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) Expanding the number of schools offering need-based debt-free medical education or short term zero-interest loans may remain aspirational goals.(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eOur findings indicate additional complexity beyond individual program accountability and student debt. Although we demonstrated a clear association between any level of medical education debt and not completing two or more visiting rotations, the relationship between debt and odds of completing any visiting rotation was not linear and will require additional research.\u003c/p\u003e \u003cp\u003eIn our study, Black students were more likely to complete two or more visiting rotations compared to their white counterparts, when adjusted for levels of debt. This may be driven by students with limited professional networks(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) who complete visiting rotations for a better opportunity to assess potential residency programs rather than relying on programs\u0026rsquo; online self-portrayal.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) However, this difference may instead reflect students completing visiting rotations in an attempt to increase their chance of successful match.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Other research demonstrates that URiM students have lower rates of transition into graduate medical education,(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and that these students already bear a disproportionate amount of debt.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) URiM students with debt may exacerbate their debt by completing more visiting rotations which ultimately may not improve their match success: despite visiting rotations being influential, only 34.7% of OBGYN program directors guarantee an interview to students on a visiting rotation and less than 25% of residents in most OBGYN residencies completed a visiting student rotation with their program.(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) We are also concerned that URiM students with debt who are advised to complete more visiting rotations to improve their chances of matching in OBGYN may decide not to apply to the specialty due to the considerable financial investment required, although these hypotheses require additional investigation.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) Individual programs instead can strengthen their mission-based holistic reviews of applications, which is a foundational strategy to promoting diversity, equity, and inclusion in residency,(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) and deemphasize the weight of the visiting rotation in the application process. The OBGYN specialty society can create residency program partnerships with Historically Black Colleges and Universities (HBCUs) and other Minority Serving Institutions to improve networking opportunities for those students(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) and consider instituting a cap on the number of visiting rotations a student can complete. Ensuring equitable opportunities to all students throughout medical school,(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) including visiting rotations, is critical for recruitment of diverse students.\u003c/p\u003e \u003cp\u003eOur study has several limitations. Our cross-sectional study is only able to establish associations with visiting rotation completion but not causality, and these self-reported data are subject to response bias. We excluded students with missing data, although data appeared to be missing at random, and we were not powered to draw conclusions for the \u0026ldquo;other\u0026rdquo; group in race and ethnicity analyses. We also lack student performance metrics, such as grades and USMLE Step scores, geographic location, and evidence of financial or cultural institutional support, which may influence the decision to participate in visiting rotations. Finally, these data are not linked to students\u0026rsquo; actual match outcomes, data which are owned by the NRMP, an independent organization not associated with AAMC. Our findings with 2 years of data are insufficient to establish a trend, and may not be generalizable to current practices, since the visiting rotation moratorium in academic year 2020-21 due to COVID-19,(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) the limit of one visiting rotation per student in the following academic year 2021-22, USMLE Step 1 now graded as pass or fail,(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) more medical schools moving to pass/fail clerkship grading,(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and virtual residency interviews(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) may have other effects on the perceived value of visiting rotations. Since the latter three issues may lead to challenges with applicant evaluation and differentiation for residency programs,(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) program directors may place even more weight on visiting rotations. Our study thus plays a critical role by identifying disparities in medical education debt and race and ethnicity in visiting rotation completion, which may be exacerbated if program directors increase the emphasis on visiting rotations.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAmong obstetrics and gynecology-bound medical students, moderate medical education debt was associated with lower odds of completing visiting rotations pre-COVID-19, with non-zero debt associated with lower odds of completing 2 or more visiting rotations compared with students with no debt. However, Black students were more likely to complete two or more visiting rotations than white students, adjusted for debt and sex. The post-pandemic changes to the OBGYN application process, including Step 1 and clerkship grade changes and virtual interviews, may increase the importance of visiting rotations and further exacerbate these disparities despite our efforts to diversify our workforce. As matching into the specialty becomes more competitive, either providing more financial support or conscientiously deemphasizing or capping the visiting rotation as part of the application will be critical in our goal for parity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOBGYN, obstetrics and gynecology\u003c/p\u003e\n\u003cp\u003eNRMP, National Resident Matching Program\u003c/p\u003e\n\u003cp\u003eURiM, underrepresented in medicine\u003c/p\u003e\n\u003cp\u003eAAMC, Association of American Medical Colleges\u003c/p\u003e\n\u003cp\u003eGQ, Graduation Questionnaire\u003c/p\u003e\n\u003cp\u003eAMCAS, American Medical College Application Service\u003c/p\u003e\n\u003cp\u003eMSQ, Matriculating Student Questionnaire\u003c/p\u003e\n\u003cp\u003eY2Q, Year 2 Questionnaire\u003c/p\u003e\n\u003cp\u003eCoronavirus disease of 2019, COVD-19\u003c/p\u003e\n\u003cp\u003eUSMLE, US Medical Licensing Exam\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate:\u003c/em\u003e This study was deemed not human subject research by the University of California, Davis Health Institutional Review Board, and consent was deemed unnecessary (Reference number 1780782-1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication:\u003c/em\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials:\u0026nbsp;\u003c/em\u003eThe data that support the findings of this study are available from the Association of American Medical Colleges (AAMC) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests:\u003c/em\u003e The authors report no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding:\u003c/em\u003e Funding for AAMC data requisition provided by the Office of Student and Resident Diversity, University of California, Davis School of Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions:\u003c/em\u003e MYH conceived of the project, with input from TMH, MN, MJW, DB, CLL and TLF on study design. TMH analyzed the data, interpreted by MYH, TMH, MN, MJW, MAT, DB, CLL and TLF. MYH wrote the main manuscript and TMH prepared figure 1, with revisions from MYH, TMH, MN, MJW, MAT, DB, CLL and TLF. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Presented in part as poster abstracts at American Congress of Obstetricians and Gynecologists District IX Annual Meeting December 2022 and Council on Resident Education in Obstetrics and Gynecology and Association of Professors in Gynecology and Obstetrics Annual Meeting March 2023.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGreenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A. 2020 Sep 1;117(35):21194\u0026ndash;200. \u003c/li\u003e\n\u003cli\u003eGomez LE, Bernet P. 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Available from: https://www.nrmp.org/wp-content/uploads/2022/09/PD-Survey-Report-2022_FINALrev.pdf\u003c/li\u003e\n\u003cli\u003eAmerican Medical Association. American Medical Association. 2023 [cited 2025 Mar 21]. Away rotation advice and requirements for medical school clinical rotations with Mark Meyer, MD. Available from: https://www.ama-assn.org/medical-students/clinical-rotations/away-rotation-advice-and-requirements-medical-school-clinical\u003c/li\u003e\n\u003cli\u003eGriffith M, DeMasi SC, McGrath AJ, Love JN, Moll J, Santen SA. Time to reevaluate the away rotation: improving return on investment for students and schools. Acad Med J Assoc Am Med Coll. 2019 Apr;94(4):496\u0026ndash;500. \u003c/li\u003e\n\u003cli\u003eHiggins E, Newman L, Halligan K, Miller M, Schwab S, Kosowicz L. Do audition electives impact match success? Med Educ Online. 2016;21:31325. \u003c/li\u003e\n\u003cli\u003eBaldwin K, Weidner Z, Ahn J, Mehta S. Are away rotations critical for a successful match in orthopaedic surgery? Clin Orthop. 2009 Dec;467(12):3340\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eBlackshaw AM, Watson SC, Bush JS. The cost and burden of the residency match in emergency medicine. West J Emerg Med. 2017 Jan;18(1):169\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eBenson NM, Stickle TR, Raszka WV. Going \u0026ldquo;Fourth\u0026rdquo; From Medical School: Fourth-Year Medical Students\u0026rsquo; Perspectives on the Fourth Year of Medical School. Acad Med J Assoc Am Med Coll. 2015 Oct;90(10):1386\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eDugger RA, El-Sayed AM, Dogra A, Messina C, Bronson R, Galea S. The color of debt: racial disparities in anticipated medical student debt in the United States. PloS One. 2013;8(9):e74693. \u003c/li\u003e\n\u003cli\u003eMcMichael B, Lee Iv A, Fallon B, Matusko N, Sandhu G. Racial and socioeconomic inequity in the financial stress of medical school. MedEdPublish 2016. 2022;12:3. \u003c/li\u003e\n\u003cli\u003eNguyen M, Chaudhry SI, Desai MM, Hajduk AM, McDade WA, Fancher TL, et al. Rates of medical student placement into graduate medical education by sex, race and ethnicity, and socioeconomic status, 2018-2021. JAMA Netw Open. 2022 Aug 26;5(8):e2229243. \u003c/li\u003e\n\u003cli\u003eAssociation of American Medical Colleges. Away rotations of U.S. medical school graduates by intended specialty, 2020 AAMC Medical School Graduation Questionnaire (GQ) [Internet]. Association of American Medical Colleges; 2020 Sep [cited 2023 Feb 7]. Available from: https://students-residents.aamc.org/media/9496/download\u003c/li\u003e\n\u003cli\u003eUSMLE Step 1 Transition to Pass/Fail Only Score Reporting | USMLE [Internet]. [cited 2024 Apr 13]. Available from: https://www.usmle.org/usmle-step-1-transition-passfail-only-score-reporting\u003c/li\u003e\n\u003cli\u003eAAMC [Internet]. [cited 2024 Apr 13]. Grading Systems Used in Medical School Programs. Available from: https://www.aamc.org/data-reports/curriculum-reports/data/grading-systems-used-medical-school-programs\u003c/li\u003e\n\u003cli\u003eAssociation of Professors of Gynecology and Obstetrics. Transforming the UME to GME transition: right resident, right program, ready day one. [Internet]. [cited 2023 Jul 31]. Available from: https://apgo.org/page/transformingtheumetogmetransition\u003c/li\u003e\n\u003cli\u003eChen KT, Royce CS, Baecher-Lind L, Bhargava R, Fleming A, Morgan HK, et al. Changes and challenges in the residency application process in obstetrics and gynecology. Am J Obstet Gynecol. 2024 Nov 1;231(5):475\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eCai F, Southworth E, Santiago S, Stephenson-Famy A, Fay E, Wang EY, et al. The golden tickets: impact of preference signaling on obstetrics and gynecology residency applicants. Am J Obstet Gynecol. 2024 Feb;230(2):262.e1-262.e9. \u003c/li\u003e\n\u003cli\u003eBanks E, Winkel AF, Morgan HK, Connolly A, Hammoud MM, George KE. Program aignaling in obstetrics and gynecology residency applications. Obstet Gynecol. 2024 Feb 1;143(2):281\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eAssociation of American Medical Colleges. 2020 AAMC Medical School Graduation Questionnaire [Internet]. Association of American Medical Colleges; 2020 [cited 2024 Dec 18]. Available from: https://www.aamc.org/media/43786/download\u003c/li\u003e\n\u003cli\u003eAAMC [Internet]. [cited 2024 Apr 13]. The Coalition for Physician Accountability\u0026rsquo;s Work Group on Away Rotations \u0026mdash; FAQs. Available from: https://www.aamc.org/about-us/mission-areas/medical-education/away-rotations-faqs\u003c/li\u003e\n\u003cli\u003eR Core Team. R: A language and environment for statistical computing [Internet]. Vienna, Austria.: R Foundation for Statistical Computing; 2021. Available from: https://www.R-project.org/\u003c/li\u003e\n\u003cli\u003eWinterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016 Nov 14;16(1):291. \u003c/li\u003e\n\u003cli\u003eU.S. Bureau of Labor Statistics. CPI Inflation Calculator [Internet]. Washington, D.C.: United States Department of Labor; [cited 2024 Jan 19]. Available from: https://www.bls.gov/data/inflation_calculator.htm\u003c/li\u003e\n\u003cli\u003eThe Coalition for Physician Accountability\u0026rsquo;s Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC): Recommendations for comprehensive improvement of the UME-GME transition [Internet]. Washington, D.C.: Coalition for Physician Accountability; 2021 Aug [cited 2023 Jul 12]. Available from: https://physicianaccountability.org/wp-content/uploads/2021/08/UGRC-Coalition-Report-FINAL.pdf\u003c/li\u003e\n\u003cli\u003eGeorge KE, Litman EA, Banks E, Morgan HK, Hammoud MM, Strand E. Away rotations in obstetrics and gynecology: a survey of program directors. J Surg Educ. 2023 Sep;80(9):1340\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eThe White House [Internet]. 2025 [cited 2025 Mar 17]. Ending radical and wasteful government DEI programs and preferencing. Available from: https://www.whitehouse.gov/presidential-actions/2025/01/ending-radical-and-wasteful-government-dei-programs-and-preferencing/\u003c/li\u003e\n\u003cli\u003ePisaniello MS, Asahina AT, Bacchi S, Wagner M, Perry SW, Wong ML, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open. 2019 Jul 2;9(7):e029980. \u003c/li\u003e\n\u003cli\u003eNorris KC, Baker RS, Taylor R, Montgomery-Rice V, Higginbotham EJ, Riley WJ, et al. Historically black medical schools: addressing the minority health professional pipeline and the public mission of care for vulnerable populations. J Natl Med Assoc. 2009 Sep;101(9):864\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eSondheimer HM, Xierali IM, Young GH, Nivet MA. Placement of US medical school graduates into graduate medical education, 2005 through 2015. JAMA. 2015 Dec 8;314(22):2409\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eBoatright D, London M, Soriano AJ, Westervelt M, Sanchez S, Gonzalo JD, et al. Strategies and best practices to improve diversity, equity, and inclusion among US graduate medical education programs. JAMA Netw Open. 2023 Feb 1;6(2):e2255110. \u003c/li\u003e\n\u003cli\u003eWeiss J, Nguementi Tiako MJ, Akingbesote ND, Keene D, Balasuriya L, Sharifi M, et al. Perspectives on medical school admission for Black students among premedical advisers at Historically Black Colleges and Universities. JAMA Netw Open. 2024 Oct 1;7(10):e2440887. \u003c/li\u003e\n\u003cli\u003eNguyen M, Sutton EH, Mason HRC. HBCUs are an undervalued resource for addressing the US physician shortage. JAMA Netw Open. 2024 Oct 23;7(10):e2440966. \u003c/li\u003e\n\u003cli\u003eNational Resident Matching Program. Results and data: 2024 main residency match. Washington DC: National Residency Matching Program; 2024. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"undergraduate medical education, obstetrics and gynecology, recruitment, medical students, away, audition, debt, race and ethnicity","lastPublishedDoi":"10.21203/rs.3.rs-5611705/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5611705/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRecruitment of a more diverse obstetrics and gynecology workforce may help improve patient outcomes, particularly among women of color. Visiting rotations play a role in competing for a position in an obstetrics and gynecology residency, however, not all students may be able to complete these expensive experiences. Our objective was to evaluate socioeconomic and other demographic differences among obstetrics and gynecology-bound students who participate in visiting rotations versus those who do not.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe obtained de-identified data from the Association of American Medical Colleges for students graduating in US allopathic medical schools 2019 or 2020. We analyzed self-reported receipt of state and/or federal assistance to obtain postsecondary education, medical education debt, sex, and race and ethnicity data using chi-square and ANOVA analyses and logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf 33,287 graduating medical students, 1978 (5.9%) indicated \u0026ldquo;Obstetrics and Gynecology\u0026rdquo; as their intended practice and included socio-demographic data; 1110 (56.1%) of these completed at least one visiting rotation. In multivariable analysis including medical education debt, race and ethnicity, and sex, students with moderate debt were less likely to complete any visiting rotation (aOR 0.68, 95% CI: 0.52, 0.89) and students with any debt were less likely to complete two or more visiting rotations than those without debt. However, Black students were significantly more likely to complete two or more rotations than white students when adjusted for debt and sex (aOR 1.48, 95% CI: 1.02, 2.11).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAmong obstetrics and gynecology-bound medical students, moderate medical education debt was associated with lower odds of completing visiting rotations when adjusted for race and ethnicity and sex. However, when adjusted for sex and debt, Black students were more likely to complete two or more visiting rotations than white students.\u003c/p\u003e","manuscriptTitle":"Cross-sectional study of obstetrics and gynecology-bound students in visiting rotations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-04 10:58:25","doi":"10.21203/rs.3.rs-5611705/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-09T05:09:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-29T03:35:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-23T14:49:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273244134254742091812184490097938423800","date":"2025-04-22T10:05:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253881894958984322297832037989989442216","date":"2025-04-06T23:03:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-03T14:31:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-02T06:49:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-25T04:08:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14865476-bf6c-4b55-8017-49757e158b6d","owner":[],"postedDate":"April 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:41:16+00:00","versionOfRecord":{"articleIdentity":"rs-5611705","link":"https://doi.org/10.1186/s12909-025-07690-x","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-07-29 16:21:07","publishedOnDateReadable":"July 29th, 2025"},"versionCreatedAt":"2025-04-04 10:58:25","video":"","vorDoi":"10.1186/s12909-025-07690-x","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07690-x","workflowStages":[]},"version":"v1","identity":"rs-5611705","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5611705","identity":"rs-5611705","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}