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Busari JO, Diffey L, Hauer KE, Lomis KD, Amiel JM, Barone MA, Schultz K, Chen HC, Damodaran A, Turner DA, Jones B, Oandasan I, Chan MK. Advancing anti-oppression and social justice in healthcare through competency-based medical education (CBME). MEDICAL TEACHER 2024; 46:1167-1174. [PMID: 38215046 DOI: 10.1080/0142159x.2023.2298763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
Competency-based medical education (CBME) focuses on preparing physicians to improve the health of patients and populations. In the context of ongoing health disparities worldwide, medical educators must implement CBME in ways that advance social justice and anti-oppression. In this article, authors describe how CBME can be implemented to promote equity pedagogy, an approach to education in which curricular design, teaching, assessment strategies, and learning environments support learners from diverse groups to be successful. The five core components of CBME programs - outcomes competency framework, progressive sequencing of competencies, learning experiences tailored to learners' needs, teaching focused on competencies, and programmatic assessment - enable individualization of learning experiences and teaching and encourage learners to partner with their teachers in driving their learning. These educational approaches appreciate each learner's background, experiences, and strengths. Using an exemplar case study, the authors illustrate how CBME can afford opportunities to enhance anti-oppression and social justice in medical education and promote each learner's success in meeting the expected outcomes of training. The authors provide recommendations for individuals and institutions implementing CBME to enact equity pedagogy.
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Affiliation(s)
- Jamiu O Busari
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Pediatrics, Dr. Horacio Oduber Hospital, Oranjestad, Aruba
| | - Linda Diffey
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Karen E Hauer
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Jonathan M Amiel
- Office of Innovation in Health Professions Education and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael A Barone
- NBME, Philadelphia, PA, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Schultz
- PGME Queen's University, Kingston, Canada
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - H Carrie Chen
- Georgetown University School of Medicine, Washington, DC, USA
| | - Arvin Damodaran
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - David A Turner
- Department of Pediatrics, Division of Pediatric Critical Care, Duke Health System, Durham, NC, USA
- Competency-Based Medical Education, American Board of Pediatrics, Chapel Hill, NC, USA
| | - Benjamin Jones
- Health Systems Collaborative, Nuffield Department of Medicine, Oxford, UK
| | - Ivy Oandasan
- Toronto General Hospital Research Institute (TGHRI), Toronto, Canada
| | - Ming-Ka Chan
- Department of Pediatrics & Child Health, Office of Leadership Education, Rady Faculty of Health Sciences and Equity, Diversity, Inclusivity and Social Justice Lead, University of Manitoba and The Children's Hospital of Winnipeg, Winnipeg, Canada
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Davis S, Martin-Holland J, Gemeda ML, Mitchell DA. An antiracism framework for educating nursing professionals. Nurs Outlook 2024; 72:102242. [PMID: 39098235 DOI: 10.1016/j.outlook.2024.102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 06/25/2024] [Accepted: 06/29/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND A conceptual, methodological, and theoretical framework is needed in Nursing Education to center racism, in the curriculum, as a root cause of health inequity. PURPOSE To provide Nursing and health professions' educators with a comprehensive unifying framework to fundamentally conceptualize and deliver a curriculum which positions racism's impact as a root cause of health inequities. METHODS Critical race theory is the underpinning for a historical analysis of racism and a critique of scientific racism, whiteness, and white supremacy ideologies that perpetuate harmful and lethal outcomes for racialized individuals and communities. RESULTS This framework conceptualizes learning, unlearning, relearning, and reflective practice as the fundamental process needed to transformative nursing education and advance health equity. DISCUSSION Methodological application is given for 1) unlearning harmful white supremacy ideology 2) learning that racism as it is embedded in every sector of American life and racial inequities are inherent in the health care system 3) relearning the importance of counternarratives and building structural competency and 4) engaging in reflective practice to challenge deficit paradigms assigned to racialized people and their communities. CONCLUSION The Antiracism Framework provides foundational principles, guiding steps, and rationale for curricula that acknowledges the critical role of racism as a barrier to achieving health equity.
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Affiliation(s)
- Sandra Davis
- National League for Nursing/Walden University School of Nursing Institute for Social Determinants of Health and Social Change, Washington, DC.
| | - Judith Martin-Holland
- UC Global Health Institute, University of California San Francisco, San Francisco, CA
| | | | - Dennis A Mitchell
- Office of the Provost, College of Dental Medicine, Columbia University, New York, NY
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Simpson AV, Hope D. When I say … widening participation. MEDICAL EDUCATION 2024; 58:780-781. [PMID: 38442917 DOI: 10.1111/medu.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
Ashley and Hope analyze the term "widening participation", indicating that nuanced approaches are needed to balance inclusivity with meaningful impact.
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Affiliation(s)
| | - David Hope
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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McDonald JA, Rincón A, Daniel R, O'Sullivan PS, Hauer KE. "It's Time to Do It, to Make It a Major Part of Medicine": Faculty Experience With a Shift Toward an Antioppressive Medical School Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:558-566. [PMID: 38166213 DOI: 10.1097/acm.0000000000005616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
PURPOSE Health inequities compel medical educators to transform curricula to prepare physicians to improve the health of diverse populations. This mandate requires curricular focus on antioppression, which is a change for faculty who learned and taught under a different paradigm. This study used the Concerns-Based Adoption Model (CBAM) to explore faculty perceptions of and experiences with a shift to a curriculum that prioritizes antioppressive content and process. METHOD In this qualitative study, authors interviewed faculty course directors and teachers at the University of California, San Francisco School of Medicine from March 2021 to January 2022. Questions addressed faculty experience and understanding regarding the curriculum shift toward antioppression, perceptions of facilitators and barriers to change, and their interactions with colleagues and learners about this change. Using the CBAM components as sensitizing concepts, the authors conducted thematic analysis. RESULTS Sixteen faculty participated. Their perceptions of their experience with the first year of an antioppression curriculum initiative were characterized by 3 broad themes: (1) impetus for change, (2) personal experience with antioppressive curricular topics, and (3) strategies necessary to accomplish the change. Faculty described 3 driving forces for the shift toward antioppressive curricula: moral imperative, response to national and local events, and evolving culture of medicine. Despite broad alignment with the change, faculty expressed uncertainties on 3 subthemes: uncertainty about what is an antioppressive curriculum, the scientific perspective, and fear. Faculty also reflected on primary facilitators and barriers to accomplishing the change. CONCLUSIONS The shift to an antioppressive curriculum compels faculty to increase their knowledge and skills and adopt a critical, self-reflective lens on the interplay of medicine and oppression. This study's findings can inform faculty development efforts and highlight curricular leadership and resources needed to support faculty through this type of curricular change.
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Edgar AK, Tai J, Bearman M. Inclusivity in health professional education: how can virtual simulation foster attitudes of inclusion? Adv Simul (Lond) 2024; 9:15. [PMID: 38693571 PMCID: PMC11061899 DOI: 10.1186/s41077-024-00290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
Disparities in accessing quality healthcare persist among diverse populations. Health professional education should therefore promote more diversity in the health workforce, by fostering attitudes of inclusion. This paper outlines the potential of virtual simulation (VS), as one method in a system of health professional education, to promote inclusion and diversity. We conceptualise how VS can allow learners to experience an alternative to what HPE currently is by drawing on two social justice theorists, Paulo Freire, and Nancy Fraser and their ideas about 'voice' and 'representation'. We present two principles for VS design and implementation: (1) giving voice to learners has the power to transform; and (2) representation in VS builds inclusion. We provide practical means of building voice and representation into VS learning activities, followed by an example. Purposeful and thoughtful integration of these principles paves the way for a more diverse and inclusive healthcare workforce.
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Affiliation(s)
- Amanda K Edgar
- Deakin Learning Futures, Deakin University, Melbourne, Australia.
- School of Education, Faculty of Arts and Education, Deakin University, Geelong, Australia.
| | - Joanna Tai
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
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Vereen RJ, Wolf MF. Physician Workforce Diversity Is Still Necessary and Achievable if It Is Intentionally Prioritized. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01953-x. [PMID: 38466513 DOI: 10.1007/s40615-024-01953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024]
Abstract
The 2023 Supreme Court Decision from Students for Fair Admissions v. Harvard and Students for Fair Admissions v. University of North Carolina threatens the current progress in achieving diversity within undergraduate and graduate medical education. This is necessary to achieve a diverse healthcare workforce, which is a key to healing historical healthcare trauma, eliminating health disparities, and providing equitable healthcare access for all communities. Although the Supreme Court decision seems obstructionist, viable opportunities exist to enhance recruitment further and solidify diversity efforts in undergraduate and graduate medical education to achieve these goals.
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Affiliation(s)
- Rasheda J Vereen
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Uniformed Services University, Carl R. Darnall Army Medical Center, Fort Cavazos, TX, USA.
| | - Mattie F Wolf
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University School of Medicine & Children's Healthcare of Atlanta, Atlanta, GA, USA
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Jain NR, Nimmon L, Bulk LY. How to … bring a JEDI (justice, equity, diversity and inclusion) lens to your research. CLINICAL TEACHER 2024; 21:e13660. [PMID: 37874114 DOI: 10.1111/tct.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Neera R Jain
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
| | - Laura Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Laura Y Bulk
- Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Arno K, Bradby C, Shappell E, Mannix A, Fix M, Jordan J, Cooney R, Krzyzaniak SM, Gottlieb M. Differences in emergency medicine resident procedural reporting by race and ethnicity. AEM EDUCATION AND TRAINING 2024; 8:e10930. [PMID: 38235392 PMCID: PMC10790187 DOI: 10.1002/aet2.10930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 01/19/2024]
Abstract
Background The recruitment, retention, and training of physicians from groups underrepresented in medicine (UiM) is critically important to the practice of emergency medicine (EM). Studies across specialties have demonstrated disparities in operative experiences among UiM resident learners who are UiM; however, there are limited data on procedural disparities in EM. Objective We sought to quantify the association between racial and ethnic identities that are UiM and the number of procedures reported among EM residents. Methods We conducted a retrospective review of procedural differences by UiM status (using self-identified race and ethnicity) among graduating EM residents at nine training programs over a 10-year period. Sites were selected to ensure diversity of program length, program type, and geography. Data from residents in combined training programs, those who did not complete their full training at that institution, and those with missing data or electing not to report race/ethnicity were excluded. We calculated median and interquartile ranges for each procedure by UiM status. We conducted multivariable regression analyses accounting for UiM status, gender, and site as well as a sensitivity analysis excluding values >3 standard deviations from the mean for each procedure. Results We collected data from 988 total residents, with 718 (73%) being non-UiM, 204 (21%) being UiM, 48 (5%) electing not to specific race/ethnicity, and 18 (2%) missing race/ethnicity data. While unadjusted data demonstrated a difference between UiM and non-UiM resident numbers across several procedures, there were no significant differences in procedures reported after accounting for gender and site in the primary or sensitivity analyses. Conclusions We did not identify a statistically significant difference in reported procedures between UiM and non-UiM residents in EM. Future work should include qualitative investigations of UiM resident experience surrounding procedures as well as mixed-methods studies to examine how these data interact.
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Affiliation(s)
- Kimbia Arno
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNew YorkUSA
| | - Cassandra Bradby
- Department of Emergency MedicineThe Brody School of Medicine at East Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Eric Shappell
- Department of Emergency MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra Mannix
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Megan Fix
- Department of Emergency MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Jaime Jordan
- Department of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Robert Cooney
- Emergency MedicineGeisinger Medical CenterDanvillePennsylvaniaUSA
| | - Sara M. Krzyzaniak
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
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Lynn TM, D’urzo KA, Vaughan-Ogunlusi O, Wiesendanger K, Colbert-Kaip S, Capcara A, Chen S, Sreenan S, Brennan MP. The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism. MEDICAL EDUCATION ONLINE 2023; 28:2176802. [PMID: 36787247 PMCID: PMC9930825 DOI: 10.1080/10872981.2023.2176802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine. METHOD A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis. RESULTS Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education. CONCLUSION This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.
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Affiliation(s)
- Thérése M. Lynn
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Katrina A. D’urzo
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Kathryn Wiesendanger
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Colbert-Kaip
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Austin Capcara
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Chen
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Sreenan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Endocrinology, Connolly Hospital, Dublin, Ireland
| | - Marian P. Brennan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Pharmacy and Biomedical Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Trabilsy M, Roberts A, Ahmed T, Silver M, Manasseh DME, Andaz C, Borgen PI, Feinberg JA. Lack of Racial Diversity in Surgery and Pathology Textbooks Depicting Diseases of the Breast. J Surg Res 2023; 291:677-682. [PMID: 37562229 DOI: 10.1016/j.jss.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The lack of racial diversity depicted in medical education texts may contribute to an implicit racial bias among clinicians. This bias influences outcomes, as familiarity with the various cutaneous manifestations of disease is essential to making an accurate diagnosis. To better understand the racial disparities in breast surgery, we sought to determine the extent of skin tone representation depicted in images of breast surgery and pathology textbooks. METHODS Textbooks were screened for color images of conditions with sufficient skin tissue present to assign the Fitzpatrick skin phototype (FSP). Figures were independently assigned an FP score (range: 1-6), and subdivided into "light skin" (FP 1-3) and "dark skin" (FP 4-6). Number of figures in each category and percentage of patients with each skin tone were calculated. RESULTS 557 figures were included. Among 12 textbooks reviewed, seven textbooks were from the discipline of surgery, while five were pathology-related. Textbook year of publication spanned from 1996 to 2018. Overall, 533 (95.7%) figures depicted patients with light skin color versus 24 (4.3%) with dark skin color. There was no association between FP score and year of textbook publication (P = 0.69). CONCLUSIONS Patient images in breast textbooks are overwhelmingly of light skin tones, excluding patients with darker skin tones. The dearth of images depicting dark skinned individuals did not improve over time. Inclusion of patients of color in future textbooks may help reduce racial disparities within breast cancer care.
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Affiliation(s)
- Maissa Trabilsy
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Arielle Roberts
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York
| | - Tahina Ahmed
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Michael Silver
- Maimonides Medical Center, Research Administration, Brooklyn, New York
| | | | - Charusheela Andaz
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York
| | - Patrick I Borgen
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York
| | - Joshua A Feinberg
- Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York.
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Hauer KE, Park YS, Bullock JL, Tekian A. "My Assessments Are Biased!" Measurement and Sociocultural Approaches to Achieve Fairness in Assessment in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S16-S27. [PMID: 37094278 DOI: 10.1097/acm.0000000000005245] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Assessing learners is foundational to their training and developmental growth throughout the medical education continuum. However, growing evidence shows the prevalence and impact of harmful bias in assessments in medical education, accelerating the urgency to identify solutions. Assessment bias presents a critical problem for all stages of learning and the broader educational system. Bias poses significant challenges to learners, disrupts the learning environment, and threatens the pathway and transition of learners into health professionals. While the topic of assessment bias has been examined within the context of measurement literature, limited guidance and solutions exist for learners in medical education, particularly in the clinical environment. This article presents an overview of assessment bias, focusing on clinical learners. A definition of bias and its manifestations in assessments are presented. Consequences of assessment bias are discussed within the contexts of validity and fairness and their impact on learners, patients/caregivers, and the broader field of medicine. Messick's unified validity framework is used to contextualize assessment bias; in addition, perspectives from sociocultural contexts are incorporated into the discussion to elaborate the nuanced implications in the clinical training environment. Discussions of these topics are conceptualized within the literature and the interventions used to date. The article concludes with practical recommendations to overcome bias and to develop an ideal assessment system. Recommendations address articulating values to guide assessment, designing assessment to foster learning and outcomes, attending to assessment procedures, promoting continuous quality improvement of assessment, and fostering equitable learning and assessment environments.
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Affiliation(s)
- Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards, and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8812-4045
| | - Yoon Soo Park
- Y.S. Park is associate professor and associate head, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Justin L Bullock
- J.L. Bullock is a fellow, Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Seattle, Washington; ORCID: http://orcid.org/0000-0003-4240-9798
| | - Ara Tekian
- A. Tekian is professor and associate dean for international education, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-9252-1588
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Punchhi G, Shum K, Sukhera J. Anti-oppressive pedagogy in medical education: A qualitative study of trainees and faculty. MEDICAL EDUCATION 2023; 57:566-573. [PMID: 36581567 DOI: 10.1111/medu.15016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/10/2022] [Accepted: 12/27/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE Despite the proliferation of interest in health equity and justice in medical education, there is limited research into the practical implementation of pedagogical approaches that align with anti-oppressive practices. This study sought to explore how to integrate anti-oppressive pedagogy into medical education. METHODS Using constructivist grounded theory, the authors conducted 19 semi-structured interviews with a continuum of medical education stakeholders including learners and faculty in a Canadian context between June and August 2021. Transcripts were iteratively analysed using constant comparative analysis. RESULTS Findings suggest that existing approaches to anti-oppressive pedagogy in medical education are misaligned with the perceived values, priorities, pace, biomedical focus and hierarchical nature of medical education, and medical practice. Although some learners are motivated to advance anti-oppressive teaching, their motivations are often related to their personal experiences of oppression. Participants suggested that transformative and structural changes are required to effectively integrate anti-oppressive pedagogy into medical education. Suggestions included a shift to community-based learning while ensuring adequate compensation for educators and addressing resistance at individual and institutional levels. CONCLUSION Anti-oppressive pedagogy does not presently align with existing medical education practices. Effectively integrating anti-oppressive approaches will require individual and institutional reflection on the values and assumptions that underpin the field before progress can be made in a meaningful and sustainable way.
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Affiliation(s)
- Gopika Punchhi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kathryn Shum
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Javeed Sukhera
- Psychiatry, Hartford Hospital Institute of Living, Hartford, Connecticut, USA
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Haas M, Triemstra J, Tam M, Neuendorf K, Reckelhoff K, Gottlieb-Smith R, Pedigo R, McTaggart S, Vasquez J, Hundert EM, Berkowitz B, Humphrey HJ, Gruppen LD. A decade of faculty development for health professions educators: lessons learned from the Macy Faculty Scholars Program. BMC MEDICAL EDUCATION 2023; 23:185. [PMID: 36973722 PMCID: PMC10041479 DOI: 10.1186/s12909-023-04155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
Faculty development (FD) programs are critical for providing the knowledge and skills necessary to drive positive change in health professions education, but they take many forms to attain the program goals. The Macy Faculty Scholars Program (MFSP), created by the Josiah Macy Jr. Foundation (JMJF) in 2010, intends to develop participants as leaders, scholars, teachers, and mentors. After a decade of implementation, an external review committee conducted a program evaluation to determine how well the program met its intended goals and defined options for ongoing improvement.The committee selected Stufflebeam's CIPP (context, input, process, products) framework to guide the program evaluation. Context and input components were derived from the MFSP description and demographic data, respectively. Process and product components were obtained through a mixed-methods approach, utilizing both quantitative and qualitative data obtained from participant survey responses, and curriculum vitae (CV).The evaluation found participants responded favorably to the program and demonstrated an overall increase in academic productivity, most pronounced during the two years of the program. Mentorship, community of practice, and protected time were cited as major strengths. Areas for improvement included: enhancing the diversity of program participants, program leaders and mentors across multiple sociodemographic domains; leveraging technology to strengthen the MFSP community of practice; and improving flexibility of the program.The program evaluation results provide evidence supporting ongoing investment in faculty educators and summarizes key strengths and areas for improvement to inform future FD efforts for both the MFSP and other FD programs.
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Affiliation(s)
- Mary Haas
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI USA
| | - Justin Triemstra
- Department of Pediatrics and Human Development, Corewell Health, Helen DeVos Children’s Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI USA
| | - Marty Tam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI USA
| | - Katie Neuendorf
- Department of Palliative and Supportive Care, Clevel and Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Katherine Reckelhoff
- College of Chiropractic, Cleveland University, Kansas City, Overland Park, KS USA
- School of Medical & Applied Sciences, Central Queensland University, Brisbane City, QLD Australia
| | | | - Ryan Pedigo
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, LA USA
| | - Suzy McTaggart
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, MI USA
| | | | - Edward M. Hundert
- Medical Education, Harvard University, Harvard Medical School, Boston, MA USA
| | - Bobbie Berkowitz
- Columbia University School of Nursing and University of Washington School of Nursing, Seattle, WA USA
| | - Holly J. Humphrey
- Josiah Macy, Jr. Foundation, New York, NY USA
- The University of Chicago, Chicago, IL USA
| | - Larry D. Gruppen
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI USA
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Macdonald LK, Bryan VD, Hachey SM, Thirsk LM. "We talk teeth": Exploring faculty EDIA (equity, diversity, inclusivity, and access) capacity in dental education. J Dent Educ 2023. [PMID: 36964999 DOI: 10.1002/jdd.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/11/2022] [Accepted: 02/17/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE There are increasing concerns regarding inequitable educational access and experiences for underrepresented populations in health education, prompting dental faculties to recognize EDIA (equity, diversity, inclusivity, and access) capacity as a strategic priority. Faculty members contribute to the establishment and reinforcement of institutionally engrained norms within learning settings with significant influence on the experience of students. Currently, there is limited literature on faculty EDIA capacity within dental education and minimal evidence to inform barriers to development. This study sought to explore how dental faculty members perceive their personal and institutional EDIA capacity and to identify current strengths and weaknesses of EDIA development within the institution of study and dental education. METHODS Using a hermeneutic study design, semi-structured interviews were conducted on a convenience sampling of dental faculty members (n = 10) and a thematic, interpretative analysis was applied. RESULTS Findings revealed six dominant themes impacting EDIA capacity. Knowledge of EDIA language, interfaculty communication, and institutional messaging are identified as weaknesses, whereas informal, community building events for EDIA development are identified as novel strengths meriting prioritization. Motivation to engage in EDIA by faculty members overall is illuminated in relation to emotionally provocative experiences. CONCLUSION Current institutional communication of EDIA is unconsciously restricting capacity building based on hierarchical and prescribed parameters. Developing capacity in dental education requires a redirection of resources to initiatives valuing social bonding over prescribed box-checking. This study reveals a new narrative of EDIA capacity within dental education and sustainable pathways for development with high transferability to other health programs.
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Affiliation(s)
| | - Venise D Bryan
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | | | - Lorraine M Thirsk
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
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15
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Yarbrough LN, Konopasky A, Wyatt TR. Experiences of agency in historically underrepresented racial and ethnic dental faculty at predominantly white institutions. J Dent Educ 2023. [PMID: 36929343 DOI: 10.1002/jdd.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/25/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE/OBJECTIVES Historically underrepresented racial and ethnic (HURE) dentists remain underrepresented in dental education and dental practice, and surprisingly, little is known about the factors that enable them to thrive. The lack of information about their experiences is a critical gap in the literature. The purpose of this critical qualitative study is to describe how HURE dental faculty in predominantly white institutions (PWIs) exercise agency to thrive and advance in academic promotion when faced with challenges and adversity in the workplace. METHODS Thirteen semi-structured interviews were conducted in 2021 and 2022 with HURE dental faculty from 10 different institutions. Interviews were audio recorded, transcribed, and analyzed using the construct of agency and tenets of critical race theory to understand how they thrive in their institutions. RESULTS HURE dental faculty experienced racism as normal from both faculty and students. Racism centered around white faculty guarding access to white spaces, including things that should be open to everyone like meetings and information about promotion. To counter this, HURE faculty engaged in individual agency by fighting for their perspectives to be heard, proxy agency by seeking and building relationships with mentors and colleagues who could use their whiteness to create change, and improvisational agency by going outside their institutions for support. CONCLUSION(S) To thrive in PWIs requires HURE faculty to exercise various forms of agency to directly or indirectly advocate for themselves as professionals. These findings have implications for dental leaders to change their existing structures and improve the work environments for HURE dental faculty.
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Affiliation(s)
- Lisa N Yarbrough
- Army Postgraduate Dental School, Postgraduate Dental College, Uniformed Services University of the Health Sciences, JBSA Fort Sam Houston, Texas, USA
| | - Abigail Konopasky
- Department of Medical Education, Dartmouth College, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Tasha R Wyatt
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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16
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Jones Q, Barnett J, Porter R, Sawin G. Casting a Wider Net: Increasing Diversity, Equity, and Inclusive Excellence in Faculty Searches. J Physician Assist Educ 2023; 34:87-90. [PMID: 36728130 DOI: 10.1097/jpa.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Quinnette Jones
- Quinnette Jones, MSW, MHS, PA-C, is clinical coordinator and an assistant professor for the Duke University Physician Assistant Program and the Duke Master of Biomedical Sciences Program in Durham, North Carolina
- Jacqueline S. Barnett, DHSc, MSHS, PA-C, is a professor of family medicine and community health, division chief of the Division of PA Studies, and program director of the Duke University Physician Assistant Program in Durham, North Carolina
- Rachel Porter, PhD, is senior education strategist and assistant professor for the Duke University Physician Assistant Program in Durham, North Carolina
- Gregory Sawin, MD, MPH, is an associate professor and vice chair for education & faculty development, Department of Family Medicine & Community Health, at Duke University in Durham, North Carolina
| | - Jacqueline Barnett
- Quinnette Jones, MSW, MHS, PA-C, is clinical coordinator and an assistant professor for the Duke University Physician Assistant Program and the Duke Master of Biomedical Sciences Program in Durham, North Carolina
- Jacqueline S. Barnett, DHSc, MSHS, PA-C, is a professor of family medicine and community health, division chief of the Division of PA Studies, and program director of the Duke University Physician Assistant Program in Durham, North Carolina
- Rachel Porter, PhD, is senior education strategist and assistant professor for the Duke University Physician Assistant Program in Durham, North Carolina
- Gregory Sawin, MD, MPH, is an associate professor and vice chair for education & faculty development, Department of Family Medicine & Community Health, at Duke University in Durham, North Carolina
| | - Rachel Porter
- Quinnette Jones, MSW, MHS, PA-C, is clinical coordinator and an assistant professor for the Duke University Physician Assistant Program and the Duke Master of Biomedical Sciences Program in Durham, North Carolina
- Jacqueline S. Barnett, DHSc, MSHS, PA-C, is a professor of family medicine and community health, division chief of the Division of PA Studies, and program director of the Duke University Physician Assistant Program in Durham, North Carolina
- Rachel Porter, PhD, is senior education strategist and assistant professor for the Duke University Physician Assistant Program in Durham, North Carolina
- Gregory Sawin, MD, MPH, is an associate professor and vice chair for education & faculty development, Department of Family Medicine & Community Health, at Duke University in Durham, North Carolina
| | - Gregory Sawin
- Quinnette Jones, MSW, MHS, PA-C, is clinical coordinator and an assistant professor for the Duke University Physician Assistant Program and the Duke Master of Biomedical Sciences Program in Durham, North Carolina
- Jacqueline S. Barnett, DHSc, MSHS, PA-C, is a professor of family medicine and community health, division chief of the Division of PA Studies, and program director of the Duke University Physician Assistant Program in Durham, North Carolina
- Rachel Porter, PhD, is senior education strategist and assistant professor for the Duke University Physician Assistant Program in Durham, North Carolina
- Gregory Sawin, MD, MPH, is an associate professor and vice chair for education & faculty development, Department of Family Medicine & Community Health, at Duke University in Durham, North Carolina
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17
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Gesing P, Pant MD, Burbage AK. Health occupations salary outcomes: intersections of student race, gender, and first-generation status. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:223-241. [PMID: 35980515 PMCID: PMC9386665 DOI: 10.1007/s10459-022-10154-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/07/2022] [Indexed: 05/21/2023]
Abstract
Greater diversity in the healthcare workforce has been identified as a critical need in serving an increasingly diverse population. Higher education institutions have been tasked with increasing the number of underrepresented students in the health occupations pipeline to better align with the demographics of the general population and meet the need for a diverse health occupations workforce. This study used the National Science Foundation's National Survey of College Graduates dataset to capture data across time, examining the intersectionality of race, gender, and first-generation status on the salary outcomes of students who earn degrees related to health occupations. Results indicate that the intersecting identities of students who earn a bachelor's degree or higher in the health professions impact salary outcomes. Results of this study have implications for higher education policies that can impact increased diversity in the health occupations workforce pipeline.
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Affiliation(s)
- Peggy Gesing
- Medical and Health Professions Education Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA.
| | - Mohan D Pant
- Master of Public Health, Eastern Virginia Medical School, Norfolk, USA
| | - Amanda K Burbage
- Medical and Health Professions Education Program, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA
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18
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Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
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Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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Mavis SC, Caruso CG, Dyess NF, Carr CB, Gerberi D, Dadiz R. Implicit Bias Training in Health Professions Education: A Scoping Review. MEDICAL SCIENCE EDUCATOR 2022; 32:1541-1552. [PMID: 36532396 PMCID: PMC9755456 DOI: 10.1007/s40670-022-01673-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
There is a recurrent call for effective implicit bias (IB) education within health professions education (HPE). We aimed to explore the state of IB education within HPE for clinical learners and IB educators using the Arksey and O'Malley scoping review framework. Thirty publications variable in curricular design met inclusion criteria. No studies assessed learner outcomes at the level of Miller's "shows" or "does" nor reported program evaluation outcomes at the level of Kirkpatrick's "behavior" or "results." Rigorous, theory-guided studies assessing behavioral change, patient care delivery, and patient outcomes are needed to move the field of IB education forward within HPE. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01673-z.
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Affiliation(s)
- Stephanie C. Mavis
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Medicine at Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Catherine G. Caruso
- Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Nicolle F. Dyess
- Department of Pediatrics, Division of Neonatal Medicine at the University of Colorado, Aurora, CO USA
| | - Cara Beth Carr
- Department of Pediatrics, Division of Neonatology at University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH USA
| | - Dana Gerberi
- Mayo Clinic College of Medicine and Science, Rochester, MN USA
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY USA
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20
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Kayingo G, Bradley-Guidry C, Burwell N, Suzuki S, Dorough R, Bester V. Assessing and benchmarking equity, diversity, and inclusion in healthcare professions. JAAPA 2022; 35:51-54. [PMID: 36282578 DOI: 10.1097/01.jaa.0000885184.50730.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Healthcare professions are among the fastest growing careers in the United States, but the issues of equity, diversity, and inclusion remain a challenge. The percentage of underrepresented minority groups is disproportionately small despite many efforts to increase workforce diversity over the past several decades. As the demographics in our nation are rapidly changing, increasing racial, ethnic, and cognitive diversity is crucial to achieving a workforce with the capacity to provide accessible and equitable healthcare. Given the growing evidence that a diverse workforce improves healthcare outcomes, fosters unique perspectives (cognitive diversity), and helps to reduce health disparities, there is an urgent need to address perennial barriers such as structural racism, biases, and stereotypes. Educational institutions should be held accountable to integrate equity, diversity, and inclusion in all aspects of healthcare professions education and practice. This article discusses potential areas for innovation and opportunities that can be leveraged in assessing and benchmarking equity, diversity, and inclusion in healthcare professions. The ability to thoroughly assess the PA profession's culture in relationship to diversity, equity, and inclusion provides an opportunity to determine how well the profession is performing, and to strategically plan for what else need to be done.
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Affiliation(s)
- Gerald Kayingo
- Gerald Kayingo is assistant dean, executive director, and a professor in the Physician Assistant Leadership and Learning Academy at the University of Maryland Baltimore. Carolyn Bradley-Guidry is interim associate dean for student affairs and diversity, inclusion, and equity in the School of Health Professions and an associate professor in the PA program at the University of Texas Southwestern Medical Center in Dallas, Tex. Nicole Burwell is director of preclerkship education and a clinical associate professor of medicine at the Stanford (Calif.) University School of Medicine. Sumihiro Suzuki is a professor in the Department of Family and Preventive Medicine and director of the Section of Biostatistics and Epidemiology and the data management center at Rush University Medical Center in Chicago, Ill. Ramona Dorough is an assistant professor at the University of Texas Southwestern Medical Center and interim associate dean of academic affairs and faculty development for the School of Health Professions. Vanessa Bester is an assistant professor and program director of the PA program at Augsburg University in Minneapolis, Minn. The authors have disclosed no potential conflicts of interest, financial or otherwise
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21
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Mavis SC, Caruso CG, Carr CB, Dyess NF, French H, Dadiz R, Vasquez M, Johnston L, Gillam-Krakauer M, Chess P, Izatt S, Payne AH, Carbajal MM, Bonachea EM, Gray MM. Consensus on an implicit bias and health disparities curriculum in neonatal medicine: a Delphi study. J Perinatol 2022; 42:1519-1526. [PMID: 36203083 DOI: 10.1038/s41372-022-01530-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite longstanding and recurrent calls for effective implicit bias (IB) education in health professions education as one mechanism to reduce ongoing racism and health disparities, such curricula for neonatal-perinatal medicine (NPM) are limited. We aim to determine the key curricular elements for educating NPM fellows, advanced practice providers, and attending physicians in the critical topics of IB and health disparities. STUDY DESIGN A modified Delphi study was performed with content experts in IB and health disparities who had educational relationships to those working and training in the neonatal intensive care unit. RESULT Three Delphi rounds were conducted from May to November 2021. Experts reached consensus on a variety of items for inclusion in the curriculum, including educational goals, learning objectives, teaching strategies, and educator principles. CONCLUSION Essential curricular components of an IB and health disparities curriculum for neonatal medicine were defined using rigorous consensus building methodology.
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Affiliation(s)
- Stephanie C Mavis
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Catherine G Caruso
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Cara Beth Carr
- Division of Neonatology, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Nicolle F Dyess
- Division of Neonatal Medicine, Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - Heather French
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Margarita Vasquez
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lindsay Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Gillam-Krakauer
- Mildred T. Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patricia Chess
- Department of Pediatrics and Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Susan Izatt
- Division of Neonatology, Duke University Medical Center, Durham, NC, USA
| | - Allison H Payne
- Division of Neonatology, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Melissa M Carbajal
- Department of Pediatrics, Section of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Elizabeth M Bonachea
- Section of Neonatology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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22
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Balmer DF, Young ME, Hunderfund ANL, Schumacher D, Zaidi Z. From What We Are Doing to Why: Describing RIME's Core Values. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S1-S3. [PMID: 35947485 DOI: 10.1097/acm.0000000000004901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is cochair, Research in Medical Education (RIME) Program Planning Committee, and professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-406
| | - Meredith E Young
- M.E. Young is cochair, Research in Medical Education (RIME) Program Planning Committee, and associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
| | - Andrea N Leep Hunderfund
- A.N.L. Hunderfund is incoming cochair, Research in Medical Education (RIME) Program Planning Committee, and tenured professor of neurology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Schumacher
- D. Schumacher is incoming cochair, Research in Medical Education (RIME) Program Planning Committee, and tenured professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zareen Zaidi
- Z. Zaidi is immediate past chair, Research in Medical Education (RIME) Program Planning Committee, and professor, George Washington School of Medicine and Health Sciences, Washington, DC; ORCID: https://orcid.org/0000-0003-4328-5766
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23
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Mathieu J, Fotsing S, Akinbobola K, Shipeolu L, Crosse K, Thomas K, Denis-LeBlanc M, Gueye A, Bekolo G. The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students. CMAJ Open 2022; 10:E937-E944. [PMID: 36280249 PMCID: PMC9640166 DOI: 10.9778/cmajo.20220192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Black medical students have been consistently underrepresented in Canadian medical schools, and data on the impact of discrimination on their medical education remain limited. In this cross-sectional study, we aimed to investigate the experiences of Black medical students through the Black Medical Students' Association of Canada (BMSAC). METHODS We developed a 63-item instrument around the domains of inclusion and diversity, wellness, discrimination, career advancement and diversity in medical education. The anonymous web-based questionnaire was sent to 128 medical students and first-year residents from all 17 Canadian medical schools via the BMSAC listserv. We obtained frequencies for demographic data and self-reported experiences. RESULTS We received 52 responses. Of respondents, 59% had at least 1 personal encounter with discrimination in medical school. Discrimination was experienced in both clinical and academic contexts, notably from patients, peers and hospital staff. Students further along in their medical training were more likely to endorse having experienced discrimination in medical school. Most respondents had positive experiences with academic and clinical inclusion, as well as resiliency in the face of discrimination. However, most respondents had negative experiences relating to reporting discrimination, their well-being, career advancement, sentiments of minority tax and low diversity in medical education. INTERPRETATION We found that discrimination has important implications on the learning experiences of Black medical students surveyed from the BMSAC. This directly challenges the notion that Canadian medical schools are impervious to racism and highlights the need for advocacy and systemic changes to eliminate institutional racism.
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Affiliation(s)
- Johanne Mathieu
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont.
| | - Salomon Fotsing
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kikelomo Akinbobola
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Lolade Shipeolu
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kien Crosse
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kimberley Thomas
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Manon Denis-LeBlanc
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Abdoulaye Gueye
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Gaelle Bekolo
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont.
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Ayyala MS, Hill J, Traba C, Soto-Greene M, Shiau S, DallaPiazza M. Teaching Health Equity in the Time of COVID-19: a Virtual Look Through the Lens of Structural Racism. J Gen Intern Med 2022; 37:2323-2326. [PMID: 35710672 PMCID: PMC9202964 DOI: 10.1007/s11606-022-07516-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the context of marked health disparities affecting historically marginalized communities, medical schools have an obligation to rapidly scale up COVID-19 education through the lens of structural racism. AIM To develop and implement a virtual curriculum on structural racism in a required COVID-19 course for medical students using "just-in-time" training. SETTING Academic medical institution during the height of COVID-19 in the spring of 2020. PARTICIPANTS Three hundred ninety-three 3rd and 4th-year medical students prior to re-entry into clinical care. PROGRAM DESCRIPTION Three educational sessions focused on (1) racial health disparities, (2) othering and pandemics, and (3) frameworks to address health inequity. The virtual teaching methods included narrated recorded presentations, reflections, and student-facilitated small group dialogue. PROGRAM EVALUATION In matched pre- and post-surveys, participants reported significant changes in their confidence in achieving the learning objectives and high satisfaction with small group peer facilitation. DISCUSSION The use of "just-in-time" training exploring the intersection between COVID-19 and structural racism facilitated the delivery of time-relevant and immediately clinically applicable content as students were preparing to re-enter a transformed clinical space. Similar approaches can be employed to adapt to changing healthcare landscapes as academic medical centers strive to build more equitable health systems.
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Affiliation(s)
- Manasa S Ayyala
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - James Hill
- Office of Student Affairs, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christin Traba
- Office of Education, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Maria Soto-Greene
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Office for Diversity and Community Engagement, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Michelle DallaPiazza
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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25
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Kumnick A, Shah K, Muller C, Bornstein K, Perone H, Herweck A, Syms S, Gutierrez SM, Mendez P, Bland S, Agarwal G, Broome M, Belkowitz J. Developing Awareness and Allies: Simulating Difficult Conversations about Microaggressions for Faculty and Students. South Med J 2022; 115:283-289. [PMID: 35504606 DOI: 10.14423/smj.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Discrimination and bias in clinical training often take the form of microaggressions, which, albeit unintentional, are detrimental to the learning environment and well-being of students. Although there are a few reports of medical schools training students to respond to microaggressions, none have included a complementery student-led faculty training module. The aim of this study was to develop and evaluate a case-based approach to improving student resilience and increasing faculty awareness of microaggressions in the clinical setting. METHODS We created four realistic cases of microaggressions and uncomfortable conversations, based on students' experiences on the wards, to implement training for incoming third-year students and their core faculty. Standardized patients were trained to effectively portray discriminatory faculty, residents, and patients. Institutional review board-approved surveys were administered and statistically analyzed to evaluate for efficacy. RESULTS Students had greater mean confidence scores for responding to microaggressions immediately and at 6 months after the sessions (P < 0.05). Faculty showed improved mean confidence and understanding of the definition of a microaggression (P < 0.05). CONCLUSIONS This approach had results similar to other studies, with the additional benefit of training faculty with the same scenarios. We believe that this method helped bridge the gap between students' notions of discrimination and faculty understanding of microaggressions.
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Affiliation(s)
- Allison Kumnick
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Khushali Shah
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Carly Muller
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Kasha Bornstein
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Hanna Perone
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexandra Herweck
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Samantha Syms
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Saily M Gutierrez
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Paul Mendez
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Sarah Bland
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Gauri Agarwal
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Broome
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
| | - Julia Belkowitz
- From the Gordon Center for Simulation and Innovation, the Departments of Medicine, Medical Education, and Pediatrics, and the Communications Skills Program, University of Miami Miller School of Medicine, Miami, Florida
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26
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Joy-Correll K, Nevill E, Bird-Matheson H, McLennan H, Quinn A, Mayer Y, Jarus T. Barriers and facilitators for Indigenous students and staff in health and human services educational programs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:501-520. [PMID: 35325338 DOI: 10.1007/s10459-022-10099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/12/2022] [Indexed: 06/14/2023]
Abstract
Indigenous Peoples are underrepresented in many of the Health and Human Services Educational Programs (HHSEP, e.g.: Nursing, Social Work). As various studies have reported the benefits of diversifying HHSEP, the barriers and facilitators of increasing the number of Indigenous Peoples in these professions must be identified. The purpose of this exploratory study is to identify and understand the barriers and facilitators Indigenous Peoples face when entering, learning or working in HHSEP. A narrative approach was used in the facilitation of culturally safe sharing circles with Indigenous students and staff to collect perspectives based on their individual experiences in HHSEP. Inductive thematic analysis was used to identify emerging themes in participant experiences and the impact of those experiences on participation in learning and working at the university in these educational programs. Results from this exploratory study identified current academic structures and ideologies rooted in colonialism, that act as barriers for engagement and inclusion of Indigenous students, staff, and clinical and academic faculty. These findings shaped the main themes of this study including negotiation of identity in different spaces, negotiating colonial structures in HHSEP, and negotiating changes and transitions in HHSEP. We anticipate these preliminary results will act as a catalyst for uncovering further changes to be made regarding attitudes, procedures, and practices present in an academic environment that limit the inclusion of Indigenous Peoples in HHSEP.
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Affiliation(s)
- Kristen Joy-Correll
- The occupational Sciences and Occupational Therapy Department, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Emilie Nevill
- The occupational Sciences and Occupational Therapy Department, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Hailey Bird-Matheson
- The School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Hali McLennan
- The School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Ashley Quinn
- The School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Yael Mayer
- The occupational Sciences and Occupational Therapy Department, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- The Counseling and Human Development Department, Faculty of Education, University of Haifa, Haifa, Israel.
| | - Tal Jarus
- The occupational Sciences and Occupational Therapy Department, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Blodgett NP, Howard VM, Phillips BC, Andolsek K, Richard-Eaglin A, Molloy MA. Developing Virtual Simulations to Confront Racism and Bias in Health Professions Education. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kristoffersson E, Hamberg K. "I have to do twice as well" - managing everyday racism in a Swedish medical school. BMC MEDICAL EDUCATION 2022; 22:235. [PMID: 35365131 PMCID: PMC8973650 DOI: 10.1186/s12909-022-03262-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/11/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Mounting evidence suggests that medical students from cultural/ethnic minority backgrounds face recurring and more or less subtle racist oppression, i.e., everyday racism. Insights into how they handle these inequalities, though, are scarce - especially in a Swedish context. In this interview study we therefore explored and analyzed the strategies used by racialized minority medical students to manage episodes of everyday racism - and their underlying motives and considerations. METHODS Individual interviews were carried out with 15 medical students (8 women, 7 men) who self-identified as having ethnic- or cultural minority backgrounds. Inspired by constructivist grounded theory, data were collected and analyzed simultaneously. RESULTS Participants strove to retain their sense of self as active students and professional future physicians - as opposed to passive and problematic 'Others'. Based on this endeavor, they tried to manage the threat of constraining stereotypes and exclusion. Due to the power relations in medical education and clinical placement settings as well as racialized students' experience of lacking both credibility and support from bystanders, few dared to speak up or report negative treatment. Instead, they sought to avoid racism by withdrawing socially and seeking safe spaces. Or, they attempted to adopt a professional persona that was resistant to racial slights. Lastly, they tried to demonstrate their capability or conform to the majority culture, in attempts to refute stereotypes. CONCLUSIONS Racism is not caused by the exposed individuals' own ways of being or acting. Therefore, behavioral changes on the part of minority students will not relieve them from discrimination. Rather, strategies such as adaptation and avoidance run the risk of re-inscribing the white majority as the norm for a medical student. However, as long as racialized minority students stand alone it is difficult for them to act in any other way. To dismantle racism in medical education, this study indicates that anti-racist policies and routines for handling discrimination are insufficient. School management should also acknowledge racially minoritized students' experiences and insights about racist practices, provide students and supervisors with a structural account of racism, as well as organize training in possible ways to act as a bystander to support victims of racism, and create a safer working environment for all.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden.
- Umeå Centre for Gender Studies, Umeå University, 901 87, Umeå, Sweden.
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden
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Avery-Desmarais SL, Hunter Revell SM, McCurry MK. A theoretical framework to promote minority PhD and DNP student success in nursing education. J Prof Nurs 2021; 37:1149-1153. [PMID: 34887033 DOI: 10.1016/j.profnurs.2021.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nursing PhD and DNP programs lack diversity and cultural responsiveness and, as a result, minority students are underrepresented in these programs. Stressors specific to being a member of a minority population, defined as minority stress, contribute to a range of barriers for ethnic/racial minority, male and LGBTQ PhD and DNP students. There is an urgent need for faculty and administrators to support minority doctoral student success by taking proactive steps to identify and begin to deconstruct these barriers. Doctorally-prepared nursing faculty serve as mentors and role models for doctoral students, provide exemplars for how to use scientific humility to research health inequities, implement evidence-based practice and develop the next generation of nurse scientists. Combating educational inequities for minority doctoral students is a first step in advancing health equity beyond academia. PURPOSE The purpose of this paper is to develop a theoretical synthesis to promote minority PhD and DNP student success in academia. THEORETICAL FRAMEWORK The minority doctoral student success (MDSS) framework was developed using Schneider's attraction-selection-attrition framework, key concepts from the literature, and professional and personal experience to capture the minority doctoral student experience. A systems approach was used to identify multi-level influences on the minority student experience, including antecedents at each stage of the academic journey, and how minority stress and opportunity inherently affect the process. CONCLUSIONS Diversity is essential to reimagine nursing doctoral education. This theoretical framework provides an approach to understanding the minority PhD and DNP student experience and the role of faculty and the academic organization in mediating barriers and creating opportunities to enhance diversity, equity, and inclusion.
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Affiliation(s)
- Shannon L Avery-Desmarais
- University of Massachusetts Dartmouth, College of Nursing and Health Sciences North Dartmouth, MA, United States of America.
| | - Susan M Hunter Revell
- University of Massachusetts Dartmouth, College of Nursing and Health Sciences North Dartmouth, MA, United States of America
| | - Mary K McCurry
- University of Massachusetts Dartmouth, College of Nursing and Health Sciences North Dartmouth, MA, United States of America
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30
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Joseph OR, Flint SW, Raymond-Williams R, Awadzi R, Johnson J. Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312771. [PMID: 34886495 PMCID: PMC8657581 DOI: 10.3390/ijerph182312771] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.
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Affiliation(s)
- Olivia Rochelle Joseph
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- Correspondence:
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Scaled Insights, Nexus, University of Leeds, Leeds LS2 3AA, UK
| | | | - Rossby Awadzi
- Postgraduate Graduate Medical Education, Northwick Park Hospital, London HA1 3UJ, UK;
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
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Persaud N, McKnight A, Butts H. Dr Alexander Augusta sought medical education in Canada but became a medical educator in America after the Civil War. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:100-102. [PMID: 35003437 PMCID: PMC8740260 DOI: 10.36834/cmej.72666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Nav Persaud
- Centre for Urban Health Solutions, St. Michael’s Hospital, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Ontario, Canada
| | - Alanna McKnight
- Ryerson School of Fashion, Ryerson University, Ontario, Canada
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Zaidi Z, Young M, Balmer DF, Park YS. Endarkening the Epistemé: Critical Race Theory and Medical Education Scholarship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:Si-Sv. [PMID: 34432718 DOI: 10.1097/acm.0000000000004373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is chair, Research in Medical Education (RIME) Program Planning Committee, and professor, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Meredith Young
- M. Young is incoming co-chair, RIME Program Planning Committee, and associate professor in the Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dorene F Balmer
- D.F. Balmer is incoming co-chair, RIME Program Planning Committee, and associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Yoon Soo Park
- Y.S. Park is immediate past chair, RIME Program Planning Committee, associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
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Zaidi Z, McOwen KS, Balmer DF, Schumacher DJ, Sukhera J, Young M, Park YS. RIME 60 Years: Celebration and Future Horizons. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S13-S16. [PMID: 34348380 DOI: 10.1097/acm.0000000000004296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This year marks the 60th anniversary (1961-2021) of Research in Medical Education (RIME). Over the past 6 decades, RIME has selected medical education research to be presented each year at the Association of American Medical Colleges Annual Meeting: Learn Serve Lead and published in a supplement of Academic Medicine. In this article, the authors surveyed RIME chairs from the past 20 years to identify ways that RIME has advanced medical education research and to generate ideas for future directions. RIME chairs described advancements in the rigor and impact of RIME research and the timeliness of the topics, often serving as a driver for cutting-edge research. They highlighted RIME's role in promoting qualitative research, introducing new epistemologies, and encouraging networking as a means of career advancement. Going forward, RIME chairs suggested (1) strengthening collaborations with formal advanced MEd and PhD degree programs, (2) creating formal mentorship channels for junior and minority faculty, and (3) promoting research related to knowledge translation.
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is chair, Research in Medical Education (RIME) Program Planning Committee, and professor, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Katherine S McOwen
- K.S. McOwen is senior director of educational affairs, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0002-1577-0206
| | - Dorene F Balmer
- D.F. Balmer is incoming co-chair, RIME Program Planning Committee, and associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
| | - Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Meredith Young
- M. Young is incoming co-chair, RIME Program Planning Committee, and associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
| | - Yoon Soo Park
- Y.S. Park is immediate past chair, RIME Program Planning Committee, associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
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Does Removing the Photograph and Name Change the Reviewer's Perception of Orthopaedic Residency Applicants? J Am Acad Orthop Surg 2021; 29:937-942. [PMID: 33417378 DOI: 10.5435/jaaos-d-20-00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/13/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Orthopaedic surgery remains the least diverse field in medicine regarding female and minority representation. Scarce literature exists evaluating the role of implicit bias in the residency application process. We hypothesized that applicants perceived as underrepresented minorities in orthopaedic surgery (URMs) based on their photograph or name would have a decreased likelihood of being invited to interview. METHODS Data from the 2018 to 2019 orthopaedic residency application cycle were collected from a single institution. Applications were classified URM or non-URM. After the application cycle was completed, the URM applications were propensity matched with non-URM applicants. Photographs and names were removed, and the applications were rereviewed by the Residency Applicant Review committee. Rank-in-group and the likelihood of being invited for an interview were compared. RESULTS Four hundred eleven applications were included with 27.5% URM and 72.5% non-URM. During the regular application cycle, 34.7% of those invited to interview were URM and 50% of those who were ranked-to-match range were URM. After propensity matching, 90 matched pairs were rereviewed with their photograph and name removed. In the regular application cycle, the URM applicant was 3.8 times more likely to get an interview than the matched non-URM applicant (odds ratio, 3.8, 95% confidence interval, 1.7 to 8.8, P = 0.0014). In the "blinded" condition, the URM candidate was 2.5 times more likely to get an interview than the non-URM candidate (odds ratio, 2.5, 95% confidence interval, 1.1 to 6.2 P = 0.034). In the unblinded condition, the URM candidate had a higher ranking within their group than the corresponding non-URM applicant (P = 0.0005). DISCUSSION Contrary to our initial hypothesis, URM applicants were invited to interview at a higher rate than non-URM applicants, both in the regular application cycle and in the propensity-matched "blinded" condition. This suggests that implicit bias based on the picture or name is not negatively affecting URM students during the application review process at our institution. LEVEL OF EVIDENCE 3.
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Hope D, Dewar A, Hothersall EJ, Leach JP, Cameron I, Jaap A. Measuring differential attainment: a longitudinal analysis of assessment results for 1512 medical students at four Scottish medical schools. BMJ Open 2021; 11:e046056. [PMID: 34479932 PMCID: PMC8420706 DOI: 10.1136/bmjopen-2020-046056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To measure Differential Attainment (DA) among Scottish medical students and to explore whether attainment gaps increase or decrease during medical school. DESIGN A retrospective analysis of undergraduate medical student performance on written assessment, measured at the start and end of medical school. SETTING Four Scottish medical schools (universities of Aberdeen, Dundee, Edinburgh and Glasgow). PARTICIPANTS 1512 medical students who attempted (but did not necessarily pass) final written assessment. MAIN OUTCOME MEASURES The study modelled the change in attainment gap during medical school for four student demographical categories (white/non-white, international/Scottish domiciled, male/female and with/without a known disability) to test whether the attainment gap grew, shrank or remained stable during medical school. Separately, the study modelled the expected versus actual frequency of different demographical groups in the top and bottom decile of the cohort. RESULTS The attainment gap grew significantly for white versus non-white students (t(449.39)=7.37, p=0.001, d=0.49 and 95% CI 0.34 to 0.58), for internationally domiciled versus Scottish-domiciled students (t(205.8) = -7, p=0.01, d=0.61 and 95% CI -0.75 to -0.42) and for male versus female students (t(1336.68)=3.54, p=0.01, d=0.19 and 95% CI 0.08 to 0.27). International, non-white and male students received higher marks than their comparison group at the start of medical school but lower marks by final assessment. No significant differences were observed for disability status. Students with a known disability, Scottish students and non-white students were over-represented in the bottom decile and under-represented in the top decile. CONCLUSIONS The tendency for attainment gaps to grow during undergraduate medical education suggests that educational factors at medical schools may-however inadvertently-contribute to DA. It is of critical importance that medical schools investigate attainment gaps within their cohorts and explore potential underlying causes.
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Affiliation(s)
- David Hope
- Medical Education Unit, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | - Avril Dewar
- Medical Education Unit, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - John Paul Leach
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, UK
| | - Isobel Cameron
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Alan Jaap
- Medical Education Unit, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
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Palfreyman LP, Joseph J, Parrott JS. Assessment of the Diversity and Inclusion Culture in a Physician Assistant Program. J Physician Assist Educ 2021; 32:164-170. [PMID: 34428191 DOI: 10.1097/jpa.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Physician assistant (PA) programs aim to foster a collaborative culture that enables stakeholders to feel included, empowered, and valued. The purpose of this study was to explore the cultural climate of diversity and inclusion in one PA program to identify areas of strength and to serve as a baseline needs assessment for future program initiatives. METHODS The study used a cross-sectional, descriptive approach for PA survey data (N = 85) to assess perceptions of diversity and inclusion of PA program students, faculty, and staff. RESULTS The respondents largely agreed that the program created an inclusive learning environment (92%), the curriculum positively affected their understanding of diversity and cultural responsiveness (84.6%), and the program had an adequate amount of inclusivity for all program stakeholders (87%). Some faculty members (25%) and students (6.2%) disagreed that faculty were open to diverse political beliefs, and 35% of the respondents believed that more emphasis could be put on religious diversity. A few students (7.7%) perceived faculty as not supportive of non-native English language speakers; students of color (11.5%) were more likely than White students (5.1%) to have this perception. CONCLUSIONS This study largely met the goal to create a professional environment of mutual respect and, ultimately, a climate of inclusiveness. It also identified opportunities for new initiatives to meet the needs of all program stakeholders. Follow-up research that distinguishes faculty from students and a multicenter study to explore perspectives based on demographic differences would be timely and useful.
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Affiliation(s)
- Lori Parlin Palfreyman
- Lori Parlin Palfreyman, MS, PA-C, is assistant director, Admissions and Program Assessment, for the Rutgers University Physician Assistant Program, Piscataway, New Jersey
- Jennifer Joseph, MS, PA-C, is on the faculty of the Rutgers University Physician Assistant Program, Piscataway, New Jersey
- James Scott Parrott, PhD, is the director of the Methodology and Statistics Support Team at Rutgers University, School of Health Professions, Newark, New Jersey
| | - Jennifer Joseph
- Lori Parlin Palfreyman, MS, PA-C, is assistant director, Admissions and Program Assessment, for the Rutgers University Physician Assistant Program, Piscataway, New Jersey
- Jennifer Joseph, MS, PA-C, is on the faculty of the Rutgers University Physician Assistant Program, Piscataway, New Jersey
- James Scott Parrott, PhD, is the director of the Methodology and Statistics Support Team at Rutgers University, School of Health Professions, Newark, New Jersey
| | - James Scott Parrott
- Lori Parlin Palfreyman, MS, PA-C, is assistant director, Admissions and Program Assessment, for the Rutgers University Physician Assistant Program, Piscataway, New Jersey
- Jennifer Joseph, MS, PA-C, is on the faculty of the Rutgers University Physician Assistant Program, Piscataway, New Jersey
- James Scott Parrott, PhD, is the director of the Methodology and Statistics Support Team at Rutgers University, School of Health Professions, Newark, New Jersey
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Coates WC, Yarris LM, Smith TY. Planning for diverse, equitable, inclusive research in health professions education: An integral thread in the ARMED MedEd research course. AEM EDUCATION AND TRAINING 2021; 5:S82-S86. [PMID: 34616978 PMCID: PMC8480509 DOI: 10.1002/aet2.10667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
Racism in medicine affects patients, trainees, and practitioners and contributes to health care inequities. An effective strategy to actively oppose the structural racism ingrained in the fabric of medicine is to intentionally and systematically address diversity, equity, and inclusion (DEI) in medical education and research. As part of ARMED MedEd, a new longitudinal cohort course in advanced research methods in medical education, sponsored by the Society for Academic Emergency Medicine, the leadership team deliberately included a nested DEI curriculum. The goal of the DEI curriculum is to reduce bias in development, recruitment, and implementation of education research studies to promote equity and inclusion in medical education, research, and ultimately, patient care. A team of medical educators with expertise in DEI developed curricular elements focusing on DEI in education research. The two major components are a didactic curriculum (including implicit bias training) to teach researchers to consider equity as they design studies and a consultative service to refine research protocols to address lingering unintended bias. A dedicated focus on DEI can be incorporated into an advanced education research methodology course to raise awareness and provide tools to avoid bias in research design and implementation of interventions. Over time, the network of education researchers who are trained in DEI awareness will grow and provide equitable offerings to their learners to mitigate health inequities.
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Affiliation(s)
- Wendy C. Coates
- University of California, Los Angeles David Geffen School of MedicineHarbor–UCLA Department of Emergency MedicineLos AngelesCaliforniaUSA
| | - Lalena M. Yarris
- Department of Emergency MedicineOregon Health & Sciences UniversityPortlandOregonUSA
| | - Teresa Y. Smith
- The State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
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An Examination of History for Promoting Diversity in Neuroscience. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:202-213. [PMID: 34393663 PMCID: PMC8349702 DOI: 10.1007/s40140-021-00464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
Purpose of Review A review of American history is presented to understand how public policy has contributed to a disproportionate burden of disease in members of underrepresented groups. A review of research conducted in the Stroke Belt provides an opportunity to examine more closely traditional and non-traditional risk factors in an effort to consider strategies for change. Recent Findings A diverse physician workforce has been offered as a way of improving care for our increasingly diverse populace. Given the expected increased prevalence of stroke in communities of color and the impact of stress from discrimination on health, proactive strategies to promote inclusion and equity to support diversity in perioperative neuroscience is warranted. Summary Public policy rooted in structural racism has left marginalized groups economically and educationally disadvantaged with less access to health care. Mistrust and fear from ongoing discrimination compels the neuroscience community to broaden their approach for developing a more reassuring and supportive educational environment for patients and trainees.
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Ufomata E, Merriam S, Puri A, Lupton K, LeFrancois D, Jones D, Nemeth A, Snydman LK, Stark R, Spagnoletti C. A Policy Statement of the Society of General Internal Medicine on Tackling Racism in Medical Education: Reflections on the Past and a Call to Action for the Future. J Gen Intern Med 2021; 36:1077-1081. [PMID: 33483823 PMCID: PMC8042052 DOI: 10.1007/s11606-020-06445-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Eloho Ufomata
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Sarah Merriam
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Internal Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Aditi Puri
- Division of Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine Lupton
- Division of General Internal Medicine at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA, USA
| | - Darlene LeFrancois
- Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Danielle Jones
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Attila Nemeth
- Division of Acute Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Laura K Snydman
- Division of General Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | - Rachel Stark
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Carla Spagnoletti
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Dutta N, Maini A, Afolabi F, Forrest D, Golding B, Salami RK, Kumar S. Promoting cultural diversity and inclusion in undergraduate primary care education. EDUCATION FOR PRIMARY CARE 2021; 32:192-197. [PMID: 33779517 DOI: 10.1080/14739879.2021.1900749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In this article, we review key factors in promoting a culturally diverse and inclusive learning environment for all undergraduate medical students, and the role of primary care educators in preparing students to work with diverse teams, patients and communities. These factors include approaches to curriculum and assessment, student community, faculty development and recruitment, and wider institutional factors. By highlighting these, including areas where further research, evaluation and consensus are needed, we hope to support further discourse on how primary care educators can promote culturally diverse and inclusive undergraduate medical education.
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Affiliation(s)
- Nina Dutta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Arti Maini
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Fola Afolabi
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dominique Forrest
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Bethany Golding
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Sonia Kumar
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Underrepresentation of Racial Minorities in Breast Surgery Literature: A Call for Increased Diversity and Inclusion. Ann Surg 2021; 273:202-207. [PMID: 32941269 DOI: 10.1097/sla.0000000000004481] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. BACKGROUND The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. METHODS Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into "White" or "non-White." Data were evaluated with pair-wise and linear regression statistics. RESULTS Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. CONCLUSIONS There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.
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Mulchan SS, Wakefield EO, Santos M. What COVID-19 Teaches Us About Implicit Bias in Pediatric Health Care. J Pediatr Psychol 2021; 46:138-143. [PMID: 33486504 PMCID: PMC7928717 DOI: 10.1093/jpepsy/jsaa131] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To highlight the role of implicit bias in contributing to existing health disparities among pediatric populations during the coronavirus disease 2019 (COVID-19) pandemic and recommend strategies to reduce its impact. METHODS A topical review of the recent literature on implicit bias describing its potential impact in key areas of pediatric health care within the context of COVID-19 was conducted. RESULTS Pediatric provider implicit bias has been found to be similar to the general population and can negatively influence clinical decision-making and outcomes for marginalized youth and families, particularly under stressful conditions such as the COVID-19 pandemic. Implicit bias can be mitigated through strategies proposed at the individual, institutional/organizational, educational, and scientific/research levels. CONCLUSIONS The additional strain on provider resources, staff, and supplies created by COVID-19 may exacerbate providers' susceptibility to implicit bias and contribute to health disparities. Pediatric psychologists are encouraged to recognize implicit biases in themselves and colleagues and promote identified strategies to reduce the impact of implicit bias on perpetuating health disparities in marginalized youth and families.
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Affiliation(s)
- Siddika S Mulchan
- Department of Pediatrics, Connecticut Children’s Medical Center, University of Connecticut School of Medicine
| | - Emily O Wakefield
- Department of Pediatrics, Connecticut Children’s Medical Center, University of Connecticut School of Medicine
| | - Melissa Santos
- Department of Pediatrics, Connecticut Children’s Medical Center, University of Connecticut School of Medicine
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Iheduru-Anderson KC, Wahi MM. Rejecting the myth of equal opportunity: an agenda to eliminate racism in nursing education in the United States. BMC Nurs 2021; 20:30. [PMID: 33563274 PMCID: PMC7871567 DOI: 10.1186/s12912-021-00548-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 02/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Unfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success. OBJECTIVE The purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US. METHODS A narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations. RESULTS Based on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field. CONCLUSIONS Recommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.
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Affiliation(s)
- Kechinyere C Iheduru-Anderson
- The Herbert H. and Grace A. Dow College of Health Professions, CHP 2215, Central Michigan University, 48859, Mount Pleasant, US.
| | - Monika M Wahi
- DethWench Professional Services, 30 Newbury Street, 3rd Floor, MA, 02116, Boston, US
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Hess L, Palermo AG, Muller D. Addressing and Undoing Racism and Bias in the Medical School Learning and Work Environment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S44-S50. [PMID: 32889933 DOI: 10.1097/acm.0000000000003706] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Racism and bias are American medicine's fatal flaw. They permeate clinical practice and biomedical research, and their influence on medical education is even more profound because it is through medical education that racism and bias are perpetuated across generations and throughout history. This insidious influence has persisted despite the stated values of the medical profession and well-intentioned efforts to lessen their impact. The authors assert that racism and bias in the learning and work environment of medical school can be mitigated only through a formal change management process that leads to change that is institutionally transformational and individually transformative. The authors describe the sequence of events at one U.S. medical school, beginning in 2016, that led from student activism to an initiative that encompasses every functional sphere within medical education. They also reflect on personal and structural lessons learned during the course of designing and implementing this initiative. Eliminating racism and bias demands that medical educators embrace a change process that is lifelong, people-centered, incremental, and nonlinear. It requires the courage to constantly course correct while never losing sight of the ultimate goal: health care and medical education that are free of racism and bias.
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Affiliation(s)
- Leona Hess
- L. Hess is director, Strategy and Equity Education Programs, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ann-Gel Palermo
- A.-G. Palermo is associate dean, Diversity and Inclusion in Biomedical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Muller
- D. Muller is dean, Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
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Psenka TM, Freedy JR, Mims LD, DeCastro AO, Berini CR, Diaz VA, Jarrett JB, Steyer TE. A cross-sectional study of United States family medicine residency programme director burnout: implications for mitigation efforts and future research. Fam Pract 2020; 37:772-778. [PMID: 32700730 PMCID: PMC7973070 DOI: 10.1093/fampra/cmaa075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Academic physician burnout is concerning. Too little is known about factors associated with residency programme director burnout. Continued uncertainty risks adverse outcomes including graduate medical education leadership turnover and negative impact on recruiting and retaining under-represented minority residency programme directors. OBJECTIVE This study assessed symptoms of burnout (emotional exhaustion, depersonalization) and depression along with evidence-based individual and environmental risk factors in a U.S. sample of family medicine residency programme directors. METHODS The omnibus 2018 Council of Academic Family Medicine Education Research Alliance survey was used to contact programme directors at all Accreditation Council for Graduate Medical Education accredited U.S. family medicine residency programmes via email. Descriptive data included programme director and programme characteristics, Areas of Worklife (workload, values and control), loneliness (lack companionship, feel left out and feel isolated), burnout (emotional exhaustion, depersonalization) and depressive symptoms. Chi-square tests contrasted descriptive variables with burnout and depressive symptoms. Logistic regression (LR) modelled associations between significant descriptive variables and burnout and depressive symptoms. RESULTS The survey response rate was 45.2% (268/590). Programme directors reported: emotional exhaustion (25.0%), depersonalization (10.3%) and depressive symptoms (25.3%). LR models found significant associations with emotional exhaustion (Workload: lacking time and other work-related resources); lack of companionship, depersonalization (North West Central residency region; Workload and lack of companionship) and depressive symptoms (Black/African American ethnicity). CONCLUSIONS One-quarter of U.S. programme directors report burnout or depressive symptoms. Future research should consider associated variables as possible intervention targets to reduce programme director distress and turnover.
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Affiliation(s)
- Tamatha M Psenka
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - John R Freedy
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa D Mims
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Alec O DeCastro
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Carole R Berini
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jennie B Jarrett
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Terrence E Steyer
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
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Park YS, Zaidi Z, O'Brien BC. RIME Foreword: What Constitutes Science in Educational Research? Applying Rigor in Our Research Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:Si-Sv. [PMID: 32769461 DOI: 10.1097/acm.0000000000003636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Yoon Soo Park
- Y.S. Park is chair, Research in Medical Education (RIME) Program Planning Committee, and director of health professions education research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Zareen Zaidi
- Z. Zaidi is incoming chair, Research in Medical Education (RIME) Program Planning Committee, and associate chief for faculty development, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Bridget C O'Brien
- B.C. O'Brien is immediate past chair, Research in Medical Education (RIME) Program Planning Committee, professor of medicine, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
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Mpalirwa J, Lofters A, Nnorom O, Hanson MD. Patients, Pride, and Prejudice: Exploring Black Ontarian Physicians' Experiences of Racism and Discrimination. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S51-S57. [PMID: 32769450 DOI: 10.1097/acm.0000000000003648] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Black physicians' and trainees' experiences of racism are not well documented in Canada, reflecting a knowledge gap needing correction to combat racism in Canadian health care. The authors undertook a descriptive study of Black physicians and trainees in the Canadian province of Ontario. The goal of this study was to report upon racism experienced by participant Ontarian physicians to challenge the purported rarity of racism in Canadian health care. METHOD An anonymous online survey of physicians and trainees who self-identify as Black (African/Afro-Canadian/African American/Afro-Caribbean) was administered in March and April 2018 through the Black Physicians' Association of Ontario (BPAO) listserv. The survey was modeled on qualitative interview guides from American studies. Snowball sampling was employed whereby BPAO members forwarded the survey to eligible colleagues (non-BPAO members) to maximize responses. Survey data were analyzed and key themes described. RESULTS Survey participants totalled 46, with a maximal response rate of 38%. Participants reported positive experiences of collegiality with Black colleagues and strong bonds with Black patients. Negative discrimination experiences included differential treatment and racism from peers, superiors, and patients. Participants reported race as a major factor in their selection of practice location, more so than selection of career. Participants also expressed a lack of mentorship, and there was a strong call for increased mentorship from mentors with similar ethno-racial backgrounds. CONCLUSIONS This study challenges the notion that racism within Canadian health care is rare. Future systematic collection of information regarding Black physicians' and trainees' experiences of racism will be key in appreciating the prevalence and nature of these experiences.
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Affiliation(s)
- Joseph Mpalirwa
- J. Mpalirwa is a family physician, Casey House, and a member of the Black Physicians' Association of Ontario, Toronto, Ontario, Canada
| | - Aisha Lofters
- A. Lofters is a family physician, associate professor, and clinician-scientist, Department of Family and Community Medicine, Women's College Hospital and University of Toronto, adjunct scientist, ICES, and a member of the Black Physicians' Association of Ontario, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-7322-0894
| | - Onye Nnorom
- O. Nnorom is a public health and preventive medicine physician and assistant professor, Dalla Lana School of Public Health and Department of Family and Community Medicine, University of Toronto, and president of the Black Physicians' Association of Ontario, Toronto, Ontario, Canada
| | - Mark D Hanson
- M.D. Hanson is a child and adolescent psychiatrist, Hospital for Sick Children, and professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-0820-4521
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48
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Maduakolam E, Madden B, Kelley T, Cianciolo AT. Beyond Diversity: Envisioning Inclusion in Medical Education Research and Practice. TEACHING AND LEARNING IN MEDICINE 2020; 32:459-465. [PMID: 33349086 DOI: 10.1080/10401334.2020.1836462] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This commentary examines the publications in Teaching and Learning in Medicine's Issue 32(5) from the perspectives of Black, female medical trainees. Its purpose is to demonstrate how including diverse perspectives in general medical education scholarship could prompt reconsideration of basic concepts and the development of richer, more nuanced, and practicable understanding of who medical learners are. An inclusive concept of medical education is a first step toward "culturally responsive universal design for learning," an approach to educational design that views barriers to learning as a systems problem, recognizes racism as a learning barrier, and offers learners multiple means to achieve academic success. Augmenting studies that explicitly target the experiences of trainees and faculty from marginalized racial groups, this commentary aims to establish a vision for what to do educationally with the knowledge that people bring diverse backgrounds and perspectives to their learning.
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Affiliation(s)
- Erica Maduakolam
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Barra Madden
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Tatiana Kelley
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Anna T Cianciolo
- Southern Illinois University School of Medicine, Springfield, Illinois, USA
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49
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Ross PT, Hart-Johnson T, Santen SA, Zaidi NLB. Considerations for using race and ethnicity as quantitative variables in medical education research. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:318-323. [PMID: 32789666 PMCID: PMC7550522 DOI: 10.1007/s40037-020-00602-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Throughout history, race and ethnicity have been used as key descriptors to categorize and label individuals. The use of these concepts as variables can impact resources, policy, and perceptions in medical education. Despite the pervasive use of race and ethnicity as quantitative variables, it is unclear whether researchers use them in their proper context. In this Eye Opener, we present the following seven considerations with corresponding recommendations, for using race and ethnicity as variables in medical education research: 1) Ensure race and ethnicity variables are used to address questions directly related to these concepts. 2) Use race and ethnicity to represent social experiences, not biological facts, to explain the phenomenon under study. 3) Allow study participants to define their preferred racial and ethnic identity. 4) Collect complete and accurate race and ethnicity data that maximizes data richness and minimizes opportunities for researchers' assumptions about participants' identity. 5) Follow evidence-based practices to describe and collapse individual-level race and ethnicity data into broader categories. 6) Align statistical analyses with the study's conceptualization and operationalization of race and ethnicity. 7) Provide thorough interpretation of results beyond simple reporting of statistical significance. By following these recommendations, medical education researchers can avoid major pitfalls associated with the use of race and ethnicity and make informed decisions around some of the most challenging race and ethnicity topics in medical education.
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Affiliation(s)
- Paula T Ross
- University of Michigan-Michigan Medicine, Ann Arbor, MI, USA.
| | | | - Sally A Santen
- Virginia Commonwealth School of Medicine, Richmond, VA, USA
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50
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Parsons S. Addressing Racial Biases in Medicine: A Review of the Literature, Critique, and Recommendations. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:371-386. [DOI: 10.1177/0020731420940961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article reviews the literature on racism in medicine in the United States and reflects on the persistent barriers to diminishing racial biases in the U.S. health care system. Espoused strategies for decreasing racial disparities and reducing racial biases among physicians are critiqued, and recommendations are offered. Those recommendations include increasing the number of minority students in medical school, using Xavier University in New Orleans, Louisiana, as the model for medical school preparation; revamping the teaching of cultural competence; ensuring the quality of non-clinical staff; and reducing the risk of burnout among medical providers.
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Affiliation(s)
- Sharon Parsons
- School of Doctoral Studies, Grand Canyon University, West Palm Beach, Florida, USA
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