Project Summary Health disparities persist in the U.S. with underserved populations suffering lower quality of care and worse outcomes. National leaders in medicine have called for widespread efforts to recruit and train underrepresented minorities in medicine (URM) to supply the physician workforce and who can serve underserved communities. Although the recruitment of URM medical students is increasing, their retention in the physician profession is less certain. For URM resident physicians, Graduate Medical Education (GME) learning environment factors that perpetuate biases due to race/ethnicity and gender have high potential to hinder their professional development and retention in medicine. These include required assessments on residents subjected to assessment bias within their training programs. Little is known nationally about the GME learning environment factors associated with URM physician assessment bias, particularly in their key formative years as residents and prior to becoming fully licensed physicians. Our overarching goal is to investigate the GME learning environment factors impacting the assessment of resident physicians training in primary care. The primary objective is to identify and test modifiable factors among URM resident physicians training in all family medicine and internal medicine GME programs using an integrated, multilevel dataset sourced from national bodies. Our hypotheses center on a multilevel conceptual model and preliminary data that includes the representation of URM and gender in the GME learning environment, and how program- related factors may impact the assessments of residents. Using multiple logistic regression and multi-level growth curve modeling, we will examine the degree to which URM representation, gender, and program factors are associated with assessment bias, and how these factors may impact the trajectory of measurements of resident learning in Accreditation Council of GME (ACGME) physician competencies for all U.S. residents training in accredited family medicine and internal medicine programs. The specific aims for this study are 1) examine whether assessment inequities for URM and women residents in the ACGME Milestone assessments are associated with representation of URM and women faculty, and 2) examine how measurements of learning trajectories for URM and women residents in the ACGME Milestone assessment ratings are associated with program factors. We have assembled a team of experts in medical education assessment, workforce diversity, medical education policy, and analytics, and expect our outcomes to inform national leaders in medical education and primary care physician workforce planning to better support URM physicians training in GME. This study also meets current demands to investigate the structural barriers that limit primary care physician workforce diversity and will align with the NIH Health Disparities Strategic Plan’s commitment to improving minority health and address t...