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Frias D, Miles M. Reframing Physician Assistant Student Mistreatment Through the Lens of Intersectionality. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:155-156. [PMID: 36696292 DOI: 10.1097/acm.0000000000005076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Dominique Frias
- Mixed methods analyst, Physician Assistant Education Association, Washington, DC; ; ORCID: https://orcid.org/0000-0002-4056-9280
| | - Monica Miles
- Visiting assistant professor of STEM education, Teachers College, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0003-0006-1842
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Ahmed A, Davidson J, Van Koughnett JA, Bütter A. Gender trends in applicants to general surgery residency programs in Canada. J Pediatr Surg 2023; 58:917-924. [PMID: 36797112 DOI: 10.1016/j.jpedsurg.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgical disciplines lag behind non-surgical disciplines in attracting female trainees. Female representation of Canadian General Surgeons has not been evaluated in recent years in the literature. The objectives of this study were to assess gender trends in applicants to Canadian General Surgery residency programs and practicing general surgeons and subspecialists. METHODS This retrospective cross-sectional study analyzed gender data for residency applicants ranking General Surgery as their first-choice discipline from publicly-available annual Canadian Residency Matching Service (CaRMS) R-1 match reports from 1998 to 2021. Aggregate gender data for practicing female physicians in General Surgery and related subspecialties, including Pediatric Surgery, obtained from annual Canadian Medical Association (CMA) census from 2000 to 2019 was also analysed. RESULTS There was a significant increase in the proportion of female applicants from 34% in 1998 to 67% in 2021 (p < 0.001) and of successfully matched candidates from 39% to 68% (p = 0.002) from 1998 to 2021. Success rates between male and female candidates were significantly different in 1998 (p < 0.001), but not in 2021 (p = 0.29). The proportion of practicing female General Surgeons also significantly increased from 10.1% in 2000 to 27.9% in 2019 (p = 0.0013), with variable trends in subspecialties. CONCLUSION Gender inequality in General Surgery residency matches has normalized since 1998. Despite females representing more than 40% of applicants and successfully matched candidates to General Surgery since 2008, a gender gap still exists amongst practicing General Surgeons and subspecialists. This suggests the need for further cultural and systemic change to mitigate gender disparities. TYPE OF STUDY Original research article, clinical research. LEVEL OF EVIDENCE Level III (Retrospective cross-sectional study).
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Affiliation(s)
- Alveena Ahmed
- Schulich School of Medicine & Dentistry, Western University, Windsor Campus, London, Ontario, Canada
| | - Jacob Davidson
- Division of Pediatric Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Julie Ann Van Koughnett
- Division of General Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andreana Bütter
- Division of Pediatric Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Division of General Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Hayward L, Mott NM, McKean EL, Dossett LA. Survey of student mistreatment experienced during the core clinical clerkships. Am J Surg 2023:S0002-9610(22)00830-3. [PMID: 36669940 DOI: 10.1016/j.amjsurg.2022.12.022] [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: 10/25/2022] [Revised: 11/28/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The goal of this study was to learn more about the potential impact of medical student mistreatment on patient safety and care. METHODS A web-based survey was sent to members of the class of 2021 and 2022 who have completed their core clerkships at a single academic institution. Descriptive statistics were performed to understand how prior and future mistreatment impacted communication among students and team members. RESULTS We received 290 of 376 responses (77.1%). 26% of respondents indicated that past mistreatment negatively impacted their communication with other team members. 30% of respondents reported that fear of future mistreatment negatively impacted their communication with other team members. CONCLUSION Mistreatment of medical students has many sources and occurs throughout the clinical curriculum. Past and fear of future student mistreatment can negatively impact intrateam communication and therefore negatively impact patient care, with the potential of causing poor patient outcomes.
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Affiliation(s)
- Laura Hayward
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Department of Internal Medicine-Pediatrics, Ann Arbor, MI, USA
| | - Nicole M Mott
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Colorado-Anschutz Medical Campus, Department of Surgery, Aurora, CO, USA
| | - Erin L McKean
- University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Department of Otolaryngology-Head and Neck Surgery, Ann Arbor, MI, USA
| | - Lesly A Dossett
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA.
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Summers OS, Medcalf R, Hubbard KA, McCarroll CS. A cross-sectional study examining perceptions of discriminatory behaviors experienced and witnessed by veterinary students undertaking clinical extra-mural studies. Front Vet Sci 2023; 10:940836. [PMID: 37187930 PMCID: PMC10175701 DOI: 10.3389/fvets.2023.940836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Recent research showed that 29% of respondents in a survey of veterinary professionals reported experiencing self-described discrimination in their workplaces. Senior colleagues and clients were responsible for discriminatory behaviors. As part of their training, veterinary students are expected to undertake extra-mural study (EMS) within these same workplaces and are likely to be vulnerable to discrimination from senior colleagues and clients. This study's objectives were to identify and characterize the pattern of perceived discriminatory behaviors (i.e., belief of being treated unfairly) that veterinary students encounter while seeing practice and explore students' attitudes toward discrimination. Methods Students at British and Irish veterinary schools who undertook some clinical EMS completed a survey of closed and open questions as part of a cross-sectional study. Demographic data and experiences of discrimination with details of incidents and reporting were collected, alongside respondent attitudes. Quantitative data were analyzed using Pearson's chi-squared analysis to analyse respondents' characteristics and their experiences of discriminatory behaviors and subsequent reporting. Qualitative content analysis was used for open-question data. Results Of the 403 respondents, 36.0% had perceived behavior they believed was discriminatory. The most frequent form of discrimination was based on gender (38.0%), followed by ethnicity (15.7%). There were significant associations between respondents' experience of discriminatory behaviors and the following characteristics: age (p = 0.0096), disability (p < 0.00001), race/ethnicity (p < 0.0001), gender/sex (p = 0.018), and LGBTQ+ status (p = 0.001). Supervising veterinarians were the most commonly reported perpetrators of discriminatory behaviors (39.3%) compared with clients (36.4%). Only 13.9% of respondents who experienced discrimination reported the event(s). Respondents with a disability were the least likely to agree with the statement that professional bodies are doing enough to tackle discrimination (p < 0.0001). Most respondents agreed that sexism is still an issue (74.4%), but men were more likely to disagree (p = 0.004). Most respondents felt that ethnic diversity needed to be increased (96.3%). Discussion Discriminatory behavior is a problem for students seeing practice, especially those with one or more protected characteristics (as defined by the UK Equality Act 2010). Improved education would need to include perspectives from minority groups to help remove discriminatory behavior from veterinary practice.
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Affiliation(s)
- Olivia S. Summers
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Rebecca Medcalf
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Katherine A. Hubbard
- Department of Sociology, Faculty of Arts and Social Sciences, University of Surrey, Guildford, United Kingdom
| | - Charlotte S. McCarroll
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- *Correspondence: Charlotte S. McCarroll
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Tayari H, Mocci R, Haji O, Dugdale AHA. Training satisfaction and well-being among veterinary anaesthesia residents: time for action. Vet Anaesth Analg 2023; 50:9-20. [PMID: 34838435 DOI: 10.1016/j.vaa.2021.06.016] [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: 11/14/2020] [Revised: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To explore the satisfaction and well-being experienced by anaesthesia residents during their training, and to investigate factors that may have influenced their experiences. STUDY DESIGN Cross-sectional online anonymous voluntary survey. SAMPLE POPULATION A total of 150 (of approximately 600 canvassed) former veterinary anaesthesia residents. METHODS Participants were invited to complete an internet-based survey regarding the satisfaction and well-being experienced during their residency. Multiple choice, categorical, dichotomous, Likert-type rating scales and slider questions were used to investigate five domains (demographic, working conditions, educational environment, training satisfaction, well-being). Sampling adequacy, questionnaire reliability and participant responses were investigated by Kaiser-Meyer-Olkin (KMO) indices, Cronbach's α and standard statistical techniques, respectively (p < 0.05). RESULTS The questionnaire demonstrated good sampling adequacy (median KMO index 0.74; range 0.51-0.89) and high item 'reliability' (α = 0.82-0.94). Of the 150 responders, (25% participation rate) 62% were satisfied, 14% were neutral and 24% were dissatisfied with their residency training; 60.6% would do the residency again, 39.3% would not or were unsure. Sex and age did not correlate with training satisfaction (p > 0.05). Salary/stipend was considered inadequate by 70% of responders; 66% received no on-call supplement. Greater supervisory input, a good working environment and extra income when on-call were positively correlated with training satisfaction (p < 0.01). The majority (94.6%) of trainees suffered from at least one medical condition during their residency, with fatigue, sleep disturbance or anxiety reported by > 62%. CONCLUSIONS Although a quarter of responders were dissatisfied with their residency, several modifiable factors were identified, particularly with respect to supervisors' input, working environment and pay, which could inform improvements for future residency programmes. Most trainees experienced negative health impacts; however, this parallels the general situation in both the medical and veterinary professions, which requires greater attention from the supervisors, trainees and colleges.
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Affiliation(s)
- Hamaseh Tayari
- ChesterGates Veterinary Specialists CVS UK (Ltd.), Chester, UK.
| | - Rita Mocci
- ChesterGates Veterinary Specialists CVS UK (Ltd.), Chester, UK
| | - Othamane Haji
- National Institute of Statistic and Applied Economics, (INSEA), Rabat, Morocco
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Holaday LW, Weiss JM, Sow SD, Perez HR, Ross JS, Genao I. Differences In Debt Among Postgraduate Medical Residents By Self-Designated Race And Ethnicity, 2014-19. Health Aff (Millwood) 2023; 42:63-73. [PMID: 36623219 PMCID: PMC9954659 DOI: 10.1377/hlthaff.2022.00446] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The US physician workforce does not reflect the racial and ethnic makeup of the country's population, despite efforts to promote diversity. Becoming a physician requires significant time and financial investment, and populations that are underrepresented in medicine have also been excluded from building wealth. Understanding the differential burden of debt by race and ethnicity may inform strategies to improve workforce diversity. We used 2014-19 data on postgraduate resident trainees from the Association of American Medical Colleges to examine the association between race and ethnicity and debt independent of other demographics and residency characteristics. Black trainees were significantly more likely to have every type of debt than the overall sample and all other racial and ethnic groups (96 percent of Black trainees had any debt versus 83 percent overall; 60 percent had premedical education loans versus 35 percent overall, and 50 percent had consumer debt versus 25 percent overall). American Indian/Alaska Native, Hispanic, and Native Hawaiian/Pacific Islander trainees were more likely to have debt compared with White and Asian trainees. Overall, debt prevalence decreased over time and varied by specialty; however, for Black trainees, debt decreased minimally over time and was stable across specialties. Scholarships, debt relief, and financial guidance should be explored to improve diversity and inclusion in medicine across specialties.
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Affiliation(s)
- Louisa W Holaday
- Louisa W. Holaday , Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jasmine M Weiss
- Jasmine M. Weiss, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sire D Sow
- Sire D. Sow, Icahn School of Medicine at Mount Sinai
| | - Hector R Perez
- Hector R. Perez, Montefiore Medical Center, New York, New York
| | - Joseph S Ross
- Joseph S. Ross, Yale University, New Haven, Connecticut
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Health care professionals' perceptions of unprofessional behaviour in the clinical workplace. PLoS One 2023; 18:e0280444. [PMID: 36656827 PMCID: PMC9851503 DOI: 10.1371/journal.pone.0280444] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. OBJECTIVE To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. METHODS Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. RESULTS Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). CONCLUSIONS Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.
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Factors Associated with Commercial Sex Behavior among Male College Students Who Engaged in Temporary Heterosexual Behavior in Zhejiang Province, China. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4319194. [PMID: 36619304 PMCID: PMC9822748 DOI: 10.1155/2022/4319194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023]
Abstract
Objective This study explored the characteristics and associated factors of commercial sex behavior among male college students who engaged in temporary heterosexual behaviors in Zhejiang Province, China. Methods The participants were male college students with temporary heterosexual behaviors. We developed an online questionnaire to collect information on demographic characteristics, sexual attitudes, sexual behaviors, and HIV/AIDS interventions through stratified cluster sampling. Chi-square (χ 2) tests were performed for the different groups of participants. The occurrence of commercial sex behavior among participants was taken as the dependent variable, and logistic regression was used to analyze the factors associated with the participants' commercial sex behavior. Results This study investigated the temporary heterosexual behavior of 424 male college students. Among them were 112 students who reported commercial sex behavior (26.42%), whose average age was 20.25 ± 1.27 years, and whose household registration of Zhejiang Province accounted for 63.39%. The results of the multivariate logistic regression analysis indicated that acceptance of commercial sex behavior (Adjusted (a) OR = 3.53, 95% CI = 1.94~6.40) and feeling at risk of contracting HIV (aOR = 6.44, 95% CI = 2.98~13.94), seeking temporary sexual partners through the Internet (aOR = 2.58, 95% CI = 1.27~5.25), consistently using condoms during sex (aOR = 0.34, 95% CI = 0.16~0.70), or using condoms sometimes/frequently during sex (aOR = 0.30, 95% CI = 0.13~0.68) were independent factors associated with male college students with temporary heterosexual behavior engaging in commercial sex behavior. Conclusion Open sexual attitudes, seeking temporary sexual partners through the Internet, high awareness of HIV infection risk, and low condom use are associated factors for male college students engaging in commercial sex behavior. For college students' HIV/AIDS prevention and education interventions, it is necessary to strengthen the prevention of network influence, increase peer education, increase teacher participation in education, enhance college students' risk awareness, advocate for the use of condoms, and promote HIV/AIDS prevention and treatment.
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Mueller L, Morenas R, Loe M, Toraih E, Turner J. Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends. Am Surg 2022:31348221146945. [PMID: 36565153 DOI: 10.1177/00031348221146945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training. METHODS Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees. RESULTS The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008). CONCLUSION Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.
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Affiliation(s)
- Lauren Mueller
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Rohan Morenas
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Mallory Loe
- School of Medicine, 12255Tulane University, New Orleans, LA, USA
| | - Eman Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, 12255Tulane University, New Orleans, LA, USA.,Genetics Unit, Department of Histology and Cell Biology, 12255Suez Canal University, Ismailia, Egypt
| | - Jacquelyn Turner
- Department of Surgery, Division of Colon and Rectal Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA
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El-Zoghby SM, Ibrahim ME, Zaghloul NM, Shehata SA, Farghaly RM. Impact of workplace violence on anxiety and sleep disturbances among Egyptian medical residents: a cross-sectional study. HUMAN RESOURCES FOR HEALTH 2022; 20:84. [PMID: 36536416 PMCID: PMC9761647 DOI: 10.1186/s12960-022-00786-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/07/2022] [Indexed: 06/13/2023]
Abstract
BACKGROUND Workplace violence (WPV) against healthcare workers is a common occurrence worldwide, especially among young physicians and medical residents. This study aimed to explore the negative health impacts of WPV among medical residents in Egypt, and their perception regarding how safe it is to report violence. PURPOSE To investigate the prevalence of WPV among medical residents, its possible negative health impacts, specifically on sleep quality and mental health, and the perceived workplace safety climate. METHODS This is a cross-sectional analytic study, using a convenience sample through an online questionnaire. An abuse index was calculated, generalized anxiety disorder (GAD) and sleep quality were collected from the reported outcomes. RESULTS The study sample included 101 residents (86.1% females). The most common reported form of abuse was verbal abuse, with the most common reported perpetrators being senior staff members (59.4%). About 86% of participants were classified as poor sleepers, while 59.4% had GAD, and there were significant positive correlations between GAD and Global Pittsburgh Sleep Quality Index (PSQI) scores with the abuse index. More than one third (35.6%) of residents reported a very high-risk Psychosocial Safety Climate (PSC) score, and 31.6% of them either strongly agreed or agreed that reporting a sexual harassment claim would be dangerous. CONCLUSION Workplace violence is common among Egyptian medical residents, with a significant negative impact on sleep quality and a rising risk of GAD. The promotion of a safe workplace environment is essential in protecting the health and wellbeing of medical residents.
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Affiliation(s)
- Safaa M. El-Zoghby
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, 41522 Egypt
| | - Maha E. Ibrahim
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, 41522 Egypt
| | - Nancy M. Zaghloul
- Department of Forensic Medicine and Clinical Toxicology, Misr University for Science and Technology, Cairo, Egypt
| | - Shaimaa A. Shehata
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Suez Canal University, Ismailia, 41522 Egypt
- Present Address: Faculty of Medicine, Suez Canal University, Ring Road, Ismailia, 41111 Egypt
| | - Rasha M. Farghaly
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, 41522 Egypt
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Erb EC, Randolph MN, Cohen-Osher M, Garg PS. Identifying Student Mistreatment Through Peer-Facilitated Learning Environment Sessions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1623-1627. [PMID: 35857397 DOI: 10.1097/acm.0000000000004882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PROBLEM Data from the Association of American Medical Colleges (AAMC) Medical School Graduation Questionnaire (GQ) show persistent high rates of medical student mistreatment, and multiple barriers to student reporting of mistreatment exist. The authors examined whether learning environment sessions (LESs) allow students opportunities to identify and describe patterns of mistreatment missed by other avenues of reporting. APPROACH Peer-facilitated LESs were instituted in 2018-2019 at Boston University School of Medicine. The LESs were scheduled once during every third-year core clerkship block. Third- and fourth-year students trained as peer-facilitators led discussions of topics relevant to the student clinical experience using a standardized facilitator guide. Minutes, including details of reported events, were completed during the session and visible to all students participating. These minutes were sent to clerkship leadership and the medical education office for action once student grades were submitted. OUTCOMES Summative content analysis was conducted on 44 LES minutes from sessions held in January-November 2019. Reported incidents were categorized into broad categories of negative treatment (NT), negative learning environment (NLE), and positive learning environment (PLE). Sixty-three instances of NT were identified. Of these, 37 fit within the scope of the AAMC GQ mistreatment categories. The remaining 26 instances of NT were classified into 7 novel categories of medical student mistreatment. Instances of NLE were most discussed by students and categorized into 5 subthemes. Examples of PLE were categorized into 4 subthemes, which encompassed 11 descriptors of core qualities of an ideal preceptor or educational environment. NEXT STEPS LESs have aided in identifying and describing new patterns of mistreatment. They fulfill a unique role by allowing students to identify, analyze, and report mistreatment in a facilitated and protected space. Formal evaluations of institutional improvement in the learning environment, reduction in medical student mistreatment, and subsequent improvement in AAMC GQ data are needed.
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Affiliation(s)
- Emily Cokorinos Erb
- E.C. Erb is an internal medicine resident, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martine N Randolph
- M.N. Randolph is a family medicine resident, Department of Family Medicine, MedStar Health Franklin Square, Baltimore, Maryland
| | - Molly Cohen-Osher
- M. Cohen-Osher is assistant professor, Department of Family Medicine, and assistant dean of medical education for curriculum and instructional design, Boston University School of Medicine, Boston, Massachusetts
| | - Priya S Garg
- P.S. Garg is assistant professor, Department of Pediatrics, and associate dean of medical education, Boston University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-7219-476X
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Nguyen M, Chaudhry SI, Asabor E, Desai MM, Lett E, Cavazos JE, Mason HRC, Boatright D. Variation in Research Experiences and Publications During Medical School by Sex and Race and Ethnicity. JAMA Netw Open 2022; 5:e2238520. [PMID: 36282497 PMCID: PMC9597391 DOI: 10.1001/jamanetworkopen.2022.38520] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/11/2022] [Indexed: 11/26/2022] Open
Abstract
Importance Diverse research teams are critical to solving complex health problems and producing high-quality medical research. Objective To examine the associations of student sex and racial and ethnic identity with publication rates during medical school. Design, Setting, and Participants This cohort study assessed individual-level data of US MD graduates from medical school who matriculated in academic years 2014 to 2015 and 2015 to 2016. Data were obtained from the Association of American Medical Colleges and analyzed from October 2021 to January 2022. Main Outcomes and Measures Outcomes of interest included students' self-reported participation in unique research experiences, number of publications, and computed publications per research experience. Poisson regressions were constructed to determine the association of sex and racial and ethnic identity with research outcomes using adjusted rate ratios (aRRs). Results Among 31 474 graduates, 15 159 (48.2%) identified as women and 4344 (13.8%) identified as underrepresented in medicine by race and ethnicity (URIM; including American Indian, Alaska Native, Black, Hawaiian Native, Hispanic/Latinx, and Pacific Islander individuals). Students who attended National Institutes of Health (NIH) top 40 research-ranked schools reported higher number of research experiences and publication counts, resulting in a higher publication rate compared with students from non-top 40 schools (median [IQR] 1.60 [1.00-3.00] vs 1.25 [0.50-2.33]; P < .001). Women reported a higher number of research experiences than men but a significantly lower number of publications (top 40 schools: aRR, 0.89; 95% CI, 0.87-0.90; non-top 40 schools: aRR, 0.93; 95% CI, 0.92-0.95). This resulted in a significantly lower publication rate among women (top 40 schools: aRR, 0.85; 95% CI, 0.83-0.86; non-top 40 schools: aRR, 0.91; 95% CI, 0.90-0.92). Compared with White students, Asian students had higher publication rates at both NIH top 40 schools (aRR, 1.10; 95% CI, 1.08-1.12) and non-top 40 schools (aRR, 1.07; 95% CI, 1.05-1.08), while lower publication rates were reported among Black students (top 40 schools: aRR, 0.83; 95% CI, 0.80-0.86; non-top 40 schools: aRR, 0.88; 95% CI, 0.85-0.95) and Hispanic students attending non-top 40 schools (aRR, 0.93; 95% CI, 0.90-0.95). Conclusions and Relevance These findings illustrate that inequities in the physician-scientist workforce began early in training and highlight key areas for intervention, such as funding support and mentorship training during undergraduate medical education, that may promote the future success of a diverse physician-scientist workforce.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Elle Lett
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jose E. Cavazos
- South Texas Medical Scientist Training Program, University of Texas Health San Antonio, San Antonio
| | | | - Dowin Boatright
- Department of Emergency Medicine, New York Grossman School of Medicine, New York
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Delk P, Bowling I, Schroeder C, Wilson TE, Wesson M, Wetherill L. An investigation of preceptors' perceptions of behavioral elements of “professionalism” among genetic counseling students. J Genet Couns 2022; 32:325-341. [PMID: 36184900 DOI: 10.1002/jgc4.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
Professionalism in health care is a loosely defined but increasingly studied concept. In genetic counseling, "professional development" expectations for entry-level genetic counselors are described in the "Practice-Based Competencies for Genetic Counselors," but the teaching and evaluation of "professionalism" among genetic counseling students is relatively unexplored. This study investigated program leaders' and clinical supervisors' perceptions of professionalism demonstrated by genetic counseling graduate students to learn about their associated strengths and lapses. Members of program leadership and clinical supervisors at Accreditation Council for Genetic Counseling (ACGC) accredited genetic counseling graduate programs in the United States and Canada were surveyed regarding their observations of genetic counseling students for the years 2017-2019 regarding four domains of professional behavior: integrity, accountability/conscientiousness, teamwork, and patient care, with the Merriam-Webster definition of each behavior provided for each domain. Participants also provided open-text descriptions. Descriptive results showed that the 263 participants found all facets of these professional behaviors to be essential. Patient care had the highest importance and was the domain with the most strengths observed among genetic counseling students. Lapses in professional behavior were identified for self-awareness, time management, and thoroughness. Free responses noted that suggestions or strategies for education about professional behavior from ACGC may improve the professional behavior of genetic counseling students and in turn, genetic counselors. Participants voiced the importance of consideration of diverse professional and cultural backgrounds in setting the expectations for professional behavior among genetic counseling students and genetic counselors so that "professionalism" in genetic counseling is not defined through a White lens. Further investigation into challenges that genetic counseling students face regarding professional behavior during their graduate training and strategies for education about these behaviors will aid in the growth and improvement of the training of genetic counselors. Given the sensitive nature of this topic, portions of this discussion may be triggering for some readers.
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Affiliation(s)
- Paula Delk
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Isabella Bowling
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Courtney Schroeder
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Theodore E. Wilson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Melissa Wesson
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics Indiana University School of Medicine Indianapolis Indiana USA
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Meeks LM, Conrad SS, Nouri Z, Moreland CJ, Hu X, Dill MJ. Patient And Coworker Mistreatment Of Physicians With Disabilities. Health Aff (Millwood) 2022; 41:1396-1402. [DOI: 10.1377/hlthaff.2022.00502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa M. Meeks
- Lisa M. Meeks, University of Michigan, Ann Arbor, Michigan
| | - Sarah S. Conrad
- Sarah S. Conrad, Association of American Medical Colleges, Washington, D.C
| | - Zakia Nouri
- Zakia Nouri, Association of American Medical Colleges
| | | | - Xiaochu Hu
- Xiaochu Hu, Association of American Medical Colleges
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Cheng SM, Taylor DL, Fitzgerald AA, Kuo CC, Graves KD. Build & Belong: A Peer-Based Intervention to Reduce Medical Student Social Isolation. TEACHING AND LEARNING IN MEDICINE 2022; 34:504-513. [PMID: 34763586 PMCID: PMC9091060 DOI: 10.1080/10401334.2021.1984921] [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: 01/12/2021] [Accepted: 08/31/2021] [Indexed: 06/13/2023]
Abstract
PROBLEM Medical school can be a socially isolating experience, particularly for students underrepresented in medicine. Social isolation and perceptions of not belonging can negatively impact students' academic performance and well-being. Therefore, interventions are needed to support students and these efforts should be appealing, brief, and low-burden. INTERVENTION Guided by evidence-based approaches, we developed the Build & Belong intervention for medical students as a brief peer-to-peer approach that consisted of four components. First, M3 and M4 students wrote reflections on belonging in medical school. Second, M3 and M4 students video recorded messages for M1 and M2 students using their written reflections. Third, M1 and M2 students watched and discussed the videos in small groups. Fourth, the M1 and M2 students wrote letters to future students. Our intervention differs from previous student belonging interventions in the peer delivery of messages. CONTEXT The Build & Belong intervention aimed to improve medical students' social belongingness. Using a longitudinal observational study design, the intervention was piloted at a medical school in the Mid-Atlantic United States in 2017-2018. Students completed surveys before and after the intervention. Paired samples tests (t-tests and Wilcoxon) assessed pre- to post-intervention changes in social isolation, social connectedness, and social assurance. IMPACT Among 63 medical students, with 25.9% from backgrounds underrepresented in medicine, we assessed follow-up outcomes in 38 students. Social isolation scores significantly decreased from baseline (M = 54.8, SD = 7.06) to follow-up (M = 51.3, SD = 6.67; p < .001). Social isolation changes were evident regardless of sex, although males reported a greater reduction (M Δ = -5.32, p < .001) than females (M Δ = -2.79, p = .014). Black/African American students had the largest reduction in social isolation (M Δ = -7.24, p = .010). Social assurance and connectedness scores did not change significantly between baseline and follow-up. Medical students appeared to resonate with messages delivered by more experienced peers (M3s and M4s), particularly messages that normalized feelings of not belonging and strategies to reduce those feelings. LESSONS LEARNED The Build & Belong intervention appears to reduce social isolation scores among medical students. This pilot test of the Build & Belong intervention provides initial evidence of the effectiveness of a brief, low-cost intervention. Build & Belong may provide a scalable strategy to reduce medical students' social isolation. Our peer-based approach is distinct from administrator-led strategies; peers were seen as trusted and reliable sources of information about belonging and ways to overcome the challenges experienced during medical school.
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Affiliation(s)
- Susan M. Cheng
- Department of Family Medicine and Office of Diversity, Equity, and Inclusion, Georgetown University School of Medicine, Washington, DC, USA
| | - David L. Taylor
- Office of Student Learning & Academic Advising, Georgetown University School of Medicine, Washington, D.C, USA
| | | | - Charlene C. Kuo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Kristi D. Graves
- Department of Oncology and Faculty Development, Georgetown University Medical Center, Washington, DC, USA
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Farkas AH, Scholcoff C, Lamberg M, Shah H, Fletcher K, Yecies E. Preparing Residents to Respond to Incidences of Gender Discrimination and Sexual Harassment: An Interactive Workshop. South Med J 2022; 115:740-744. [DOI: 10.14423/smj.0000000000001459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Mike EV. Commentary on "The Performance". ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1475. [PMID: 36198158 DOI: 10.1097/01.acm.0000890492.41377.be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Elise V Mike
- E.V. Mike is a first-year ophthalmology resident, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland; ; Twitter: @EliseVMike; ORCID: 0000-0002-5913-4332
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Bellamy JL, Fralinger D, Schultzel M, Hammouri Q, Letzelter J, Bridges CM, Odum SM, Samora J. New Beginnings and Revealing Invisible Identities. J Bone Joint Surg Am 2022; 104:e79. [PMID: 35383663 DOI: 10.2106/jbjs.22.00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | | | - Qusai Hammouri
- Cohen Children's Northwell Health, Staten Island, New York
| | | | | | - Susan M Odum
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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Hill KA, Desai MM, Chaudhry SI, Nguyen M, McDade W, Xu Y, Li F, Fancher T, Hajduk AM, Westervelt MJ, Boatright D. Association of Marginalized Identities With Alpha Omega Alpha Honor Society and Gold Humanism Honor Society Membership Among Medical Students. JAMA Netw Open 2022; 5:e2229062. [PMID: 36069984 PMCID: PMC9453541 DOI: 10.1001/jamanetworkopen.2022.29062] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Disparities in medical student membership in Alpha Omega Alpha (AOA) are well documented. Less is known about Gold Humanism Honor Society (GHHS) membership and it remains unknown how the intersection of different identities is associated with membership in these honor societies. OBJECTIVE To examine the association between honor society membership and medical student race and ethnicity, sex, sexual orientation, socioeconomic status, and intersection of identities. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from Association of American Medical Colleges data collection instruments. The study included all students who graduated from Liaison Committee on Medical Education-accredited US medical schools from 2016 to 2019 and completed the Graduation Questionnaire. Data analysis was conducted from January 12 to July 12, 2022. MAIN OUTCOMES AND MEASURES Likelihood of AOA and GHHS membership by student race and ethnicity, sex, sexual orientation, childhood family income, and intersection of identities. RESULTS The sample of 50 384 individuals comprised 82 (0.2%) American Indian or Alaska Native, 10 601 (21.0%) Asian, 2464 (4.9%) Black, 3291 (6.5%) Hispanic, 25 (0.1%) Native Hawaiian or Pacific Islander, 30 610 (60.8%) White, 2476 (4.9%) multiracial students, and 834 (1.7%) students of other races or ethnicities. Sex and sexual orientation included 25 672 (51.0%) men and 3078 (6.1%) lesbian, gay, and bisexual (LGB). Childhood family income comprised 31 758 (60.0%) individuals with $75 000 per year or greater, 8160 (16.2%) with $50 000 to $74 999 per year, 6864 (13.6%) with $25 000 to $49 999 per year, and 3612 (7.2%) with less than $25 000 per year. The sample included 7303 (14.5%) AOA members only, 4925 (9.8%) GHHS members only, and 2384 (4.7%) members of both societies. In AOA, American Indian or Alaska Native (OR, 0.49; 95% CI, 0.25-0.96), Asian (OR, 0.49; 95% CI, 0.45-0.53), Black (OR, 0.25; 95% CI, 0.20-0.30), Hispanic (OR, 0.53; 95% CI, 0.47-0.59), multiracial (OR, 0.69; 95% CI, 0.62-0.77), and other race and ethnicity (OR, 0.73; 95% CI, 0.60-0.88) were underrepresented compared with White students; LGB students (OR, 0.75; 95% CI, 0.67-0.83) were underrepresented compared with heterosexual students; and childhood family income $50 000 to $74 999 (OR, 0.81; 95% CI, 0.75-0.86), $25 000 to $49 999 (OR, 0.68; 95% CI, 0.62-0.74), and less than $25 000 (OR, 0.60; 95% CI, 0.53-0.69) were underrepresented compared with greater than or equal to $75 000. In GHHS, Asian students (OR, 0.80; 95% CI, 0.73-0.87) were underrepresented compared with White students, female students (OR, 1.55; 95% CI, 1.45-1.65) were overrepresented compared with male students, LGB students (OR, 1.36; 95% CI, 1.23-1.51) were overrepresented compared with heterosexual students, and students with childhood family income $25 000 to $49 999 (OR, 0.85; 95% CI, 0.78-0.94) and less than $25 000 (OR, 0.75; 95% CI, 0.66-0.86) were underrepresented compared with those with greater than or equal to $75 000. Likelihood of AOA, but not GHHS, membership decreased as number of marginalized identities increased. CONCLUSIONS AND RELEVANCE In this cross-sectional study of US medical students, membership disparities were noted in both AOA and GHHS. However, differences in GHHS existed across fewer identities, sometimes favored the marginalized group, and were not cumulative.
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Affiliation(s)
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - William McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Yunshan Xu
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Fangyong Li
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Tonya Fancher
- Department of Internal Medicine and Office of Workforce Innovation and Community Engagement, University of California Davis
| | - Alexandria M. Hajduk
- Training Program in Geriatric Clinical Epidemiology & Aging-Related Research, Yale School of Medicine, New Haven, Connecticut
| | | | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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Nguyen M, Chaudhry SI, Desai MM, Chen C, McDade WA, Fancher TL, Boatright D. Association of Mistreatment and Discrimination With Medical School Attrition. JAMA Pediatr 2022; 176:935-937. [PMID: 35639402 PMCID: PMC9157380 DOI: 10.1001/jamapediatrics.2022.1637] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology and Office of Diversity, Equity, Inclusion, and Belonging, Yale School of Public Health, New Haven, Connecticut
| | - Candice Chen
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - William A. McDade
- Accrediation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Nguyen M, Chaudhry SI, Desai MM, Chen C, Mason HRC, McDade WA, Fancher TL, Boatright D. Association of Sociodemographic Characteristics With US Medical Student Attrition. JAMA Intern Med 2022; 182:917-924. [PMID: 35816334 PMCID: PMC9274446 DOI: 10.1001/jamainternmed.2022.2194] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Diversity in the medical workforce is critical to improve health care access and achieve equity for resource-limited communities. Despite increased efforts to recruit diverse medical trainees, there remains a large chasm between the racial and ethnic and socioeconomic composition of the patient population and that of the physician workforce. Objective To analyze student attrition from medical school by sociodemographic identities. Design, Setting, and Participants This retrospective cohort study included allopathic doctor of medicine (MD)-only US medical school matriculants in academic years 2014-2015 and 2015-2016. The analysis was performed from July to September 2021. Main Outcomes and Measures The main outcome was attrition, defined as withdrawal or dismissal from medical school for any reason. Attrition rate was explored across 3 self-reported marginalized identities: underrepresented in medicine (URiM) race and ethnicity, low income, and underresourced neighborhood status. Logistic regression was assessed for each marginalized identity and intersections across the 3 identities. Results Among 33 389 allopathic MD-only medical school matriculants (51.8% male), 938 (2.8%) experienced attrition from medical school within 5 years. Compared with non-Hispanic White students (423 of 18 213 [2.3%]), those without low income (593 of 25 205 [2.3%]), and those who did not grow up in an underresourced neighborhood (661 of 27 487 [2.4%]), students who were URiM (Hispanic [110 of 2096 (5.2%); adjusted odds ratio (aOR), 1.41; 95% CI, 1.13-1.77], non-Hispanic American Indian/Alaska Native/Native Hawaiian/Pacific Islander [13 of 118 (11.0%); aOR, 3.20; 95% CI, 1.76-5.80], and non-Hispanic Black/African American [120 of 2104 (5.7%); aOR, 1.41; 95% CI, 1.13-1.77]), those who had low income (345 of 8184 [4.2%]; aOR, 1.33; 95% CI, 1.15-1.54), and those from an underresourced neighborhood (277 of 5902 [4.6%]; aOR, 1.35; 95% CI, 1.16-1.58) were more likely to experience attrition from medical school. The rate of attrition from medical school was greatest among students with all 3 marginalized identities (ie, URiM, low income, and from an underresourced neighborhood), with an attrition rate 3.7 times higher than that among students who were not URiM, did not have low income, and were not from an underresourced neighborhood (7.3% [79 of 1086] vs 1.9% [397 of 20 353]; P < .001). Conclusions and Relevance This retrospective cohort study demonstrated a significant association of medical student attrition with individual (race and ethnicity and family income) and structural (growing up in an underresourced neighborhood) measures of marginalization. The findings highlight a need to retain students from marginalized groups in medical school.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Chronic Disease Epidemiology Department, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Candice Chen
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - William A. McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, Geriatrics and Bioethics, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Alvarez K, Cervantes PE, Nelson KL, Seag DEM, Horwitz SM, Hoagwood KE. Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change. J Am Acad Child Adolesc Psychiatry 2022; 61:1087-1105. [PMID: 34971730 PMCID: PMC9237180 DOI: 10.1016/j.jaac.2021.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racism is a public health crisis that impacts on children's mental health, yet mental health service systems are insufficiently focused on addressing racism. Moreover, a focus on interpersonal racism and on individual coping with the impacts of racism has been prioritized over addressing structural racism at the level of the service system and associated institutions. In this paper, we examine strategies to address structural racism via policies affecting children's mental health services. METHOD First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health. RESULTS Our analysis highlights gaps and opportunities in the evidence base for policy implementation strategies, including the following: mental health services for youth of color, interventions addressing interpersonal racism and bias in the mental health service system, interventions addressing structural racism, changes to provider licensure and license renewal, and development of the community health workforce. CONCLUSION Recommendations are provided both within and across systems to catalyze broader systems transformation.
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Affiliation(s)
- Kiara Alvarez
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | - Katherine L Nelson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Merck & Co., Inc., Kenilworth, New Jersey
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Klein R, Ufere NN, Schaeffer S, Julian KA, Rao SR, Koch J, Volerman A, Snyder ED, Thompson V, Ganguli I, Burnett-Bowie SAM, Palamara K. Association Between Resident Race and Ethnicity and Clinical Performance Assessment Scores in Graduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1351-1359. [PMID: 35583954 PMCID: PMC9910786 DOI: 10.1097/acm.0000000000004743] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To assess the association between internal medicine (IM) residents' race/ethnicity and clinical performance assessments. METHOD The authors conducted a cross-sectional analysis of clinical performance assessment scores at 6 U.S. IM residency programs from 2016 to 2017. Residents underrepresented in medicine (URiM) were identified using self-reported race/ethnicity. Standardized scores were calculated for Accreditation Council for Graduate Medical Education core competencies. Cross-classified mixed-effects regression assessed the association between race/ethnicity and competency scores, adjusting for rotation time of year and setting; resident gender, postgraduate year, and IM In-Training Examination percentile rank; and faculty gender, rank, and specialty. RESULTS Data included 3,600 evaluations by 605 faculty of 703 residents, including 94 (13.4%) URiM residents. Resident race/ethnicity was associated with competency scores, with lower scores for URiM residents (difference in adjusted standardized scores between URiM and non-URiM residents, mean [standard error]) in medical knowledge (-0.123 [0.05], P = .021), systems-based practice (-0.179 [0.05], P = .005), practice-based learning and improvement (-0.112 [0.05], P = .032), professionalism (-0.116 [0.06], P = .036), and interpersonal and communication skills (-0.113 [0.06], P = .044). Translating this to a 1 to 5 scale in 0.5 increments, URiM resident ratings were 0.07 to 0.12 points lower than non-URiM resident ratings in these 5 competencies. The interaction with faculty gender was notable in professionalism (difference between URiM and non-URiM for men faculty -0.199 [0.06] vs women faculty -0.014 [0.07], P = .01) with men more than women faculty rating URiM residents lower than non-URiM residents. Using the 1 to 5 scale, men faculty rated URiM residents 0.13 points lower than non-URiM residents in professionalism. CONCLUSIONS Resident race/ethnicity was associated with assessment scores to the disadvantage of URiM residents. This may reflect bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.
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Affiliation(s)
- Robin Klein
- R. Klein is associate professor, Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nneka N Ufere
- N.N. Ufere is instructor of medicine, Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Schaeffer
- S. Schaeffer is associate professor, Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine A Julian
- K.A. Julian is professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Sowmya R Rao
- S.R. Rao is statistician, Department of Global Health, Boston University School of Public Health and Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Jennifer Koch
- J. Koch is professor, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Anna Volerman
- A. Volerman is associate professor, Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Erin D Snyder
- E.D. Snyder is professor, Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Vanessa Thompson
- V. Thompson is associate professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Ishani Ganguli
- I. Ganguli is assistant professor, Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sherri-Ann M Burnett-Bowie
- S.-A.M. Burnett-Bowie is assistant professor, Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerri Palamara
- K. Palamara is associate professor, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Duong AT, Law JC, Ramirez DA, Woreta F, Sun G. Advancing Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Diversity, Equity, and Inclusion in Ophthalmology. Ophthalmology 2022; 129:1232-1234. [PMID: 35987664 DOI: 10.1016/j.ophtha.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
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Cleveland Manchanda EC, Ling AY, Bottcher JL, Marsh RH, Brown DFM, Bennett CL, Yiadom MYAB. Three decades of demographic trends among academic emergency physicians. J Am Coll Emerg Physicians Open 2022; 3:e12781. [PMID: 35982985 PMCID: PMC9375047 DOI: 10.1002/emp2.12781] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/16/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time. Methods Data from the Association of American Medical Colleges faculty roster (1990-2020) were used to assess the changing demographics of full-time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups. Results The number of full-time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03-1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n = 3, 1.40% in 1990 to n = 326, 5.55% in 2020; OR 1.01, 95% CI 1.01-1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31-year study period (N = 9, 4.21% in 1990 and N = 266, 4.53% in 2020; OR 1.00, 95% CI 0.99-1.00). Conclusions Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.
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Affiliation(s)
- Emily C. Cleveland Manchanda
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Albee Y. Ling
- Quantitative Sciences UnitStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | - Regan H. Marsh
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - David F. M. Brown
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Christopher L. Bennett
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Maame Yaa A. B. Yiadom
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
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Lockman TJ. A Pilot Study of Sexual and Gender Minority Student Experiences in Application to U.S. Medical Schools. JOURNAL OF HOMOSEXUALITY 2022; 69:1485-1500. [PMID: 33877008 DOI: 10.1080/00918369.2021.1917221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexual and gender minority (SGM) students in the United States experience adverse dynamics as undergraduates and as medical students, including discrimination or fear of it, heightened stress, and lower social support. Yet little is known about the experiences of SGM medical school applicants. An original survey distributed via SGM student groups at 10 allopathic medical schools in the Midwest yielded quantitative and qualitative data about disclosure of SGM identities during application, experiences of support and discrimination, and resources used. A majority (61.9%) of respondents (n = 42) withheld SGM identities during primary application, most often due to fear of discrimination. A majority (73.8%) expected little or no support from medical schools when deciding whether to disclose SGM identities. Four (12.9%) of 31 total respondents who at some point disclosed an SGM identity experienced discrimination, and three of five (60.0%) gender minorities who disclosed experienced discrimination. Recommendations are offered in light of results.
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Affiliation(s)
- Tyler J Lockman
- School of Education and Social Policy, Northwestern University, Evanston, Illinois, USA
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Wickramasinghe A, Essén B, Ziaei S, Surenthirakumaran R, Axemo P. Ragging, a Form of University Violence in Sri Lanka-Prevalence, Self-Perceived Health Consequences, Help-Seeking Behavior and Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148383. [PMID: 35886237 PMCID: PMC9318855 DOI: 10.3390/ijerph19148383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
Ragging is an initiation ritual practiced in Sri Lankan universities for generations, although research is scarce. This practice has several adverse consequences such as physical, psychological, and behavioral effects and increased university dropouts. The aim of this study was to investigate the prevalence of different types of ragging: emotional/verbal, physical and sexual ragging, self-perceived health consequences, help-seeking behavior, and factors associated with the experience of ragging. A cross-sectional study was conducted among 623, second- and third-year students from the medical, and technology faculties in Jaffna University. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Ragging was experienced by 59% of the students, emotional/verbal ragging being the most common. A total of 54% of students suffered one or more health consequences and mainly sought help from friends and family, with few seeking formal help. Factors associated with any type of ragging were faculty and year of study. This study emphasizes the urgent need to address this public health problem. It is important that there are adequate student support services, planning and implementation of effective interventions, as well as ensuring that existing policies are strengthened, to reduce or eliminate ragging in Sri Lanka.
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Affiliation(s)
- Ayanthi Wickramasinghe
- Department of Women and Children’s Health, International Maternal and Child Health Unit (IMCH), Uppsala University, 75185 Uppsala, Sweden; (B.E.); (S.Z.); (P.A.)
- Correspondence: ; Tel.:+46-725646591
| | - Birgitta Essén
- Department of Women and Children’s Health, International Maternal and Child Health Unit (IMCH), Uppsala University, 75185 Uppsala, Sweden; (B.E.); (S.Z.); (P.A.)
| | - Shirin Ziaei
- Department of Women and Children’s Health, International Maternal and Child Health Unit (IMCH), Uppsala University, 75185 Uppsala, Sweden; (B.E.); (S.Z.); (P.A.)
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna 70140, Sri Lanka;
| | - Pia Axemo
- Department of Women and Children’s Health, International Maternal and Child Health Unit (IMCH), Uppsala University, 75185 Uppsala, Sweden; (B.E.); (S.Z.); (P.A.)
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Klein R, Koch J, Snyder ED, Volerman A, Simon W, Jassal SK, Cosco D, Cioletti A, Ufere NN, Burnett-Bowie SAM, Palamara K, Schaeffer S, Julian KA, Thompson V. Association of Gender and Race/Ethnicity with Internal Medicine In-Training Examination Performance in Graduate Medical Education. J Gen Intern Med 2022; 37:2194-2199. [PMID: 35710653 PMCID: PMC9296734 DOI: 10.1007/s11606-022-07597-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern. OBJECTIVE Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity. DESIGN Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014-2019. ITE trends across PGY of women and URiM residents compared to non-URiM men assessed via ANOVA. Those with ITE scores associated with less than 90% probability of passing the American Board of Internal Medicine certification exam (ABIM-CE) were identified and odds of being identified as at-risk between groups were assessed with chi square. PARTICIPANTS A total of 689 IM residents, including 330 women and URiM residents (48%). MAIN MEASURES ITE score KEY RESULTS: There was a significant difference in ITE score across PGY for women and URiM residents compared to non-URiM men (F(2, 1321) 4.46, p=0.011). Adjusting for program, calendar year, and baseline ITE, women and URiM residents had smaller ITE score gains (adjusted mean change in score between PGY1 and PGY3 (se), non-URiM men 13.1 (0.25) vs women and URiM residents 11.4 (0.28), p<0.001). Women and URiM residents had greater odds of being at potential risk for not passing the ABIM-CE (OR 1.75, 95% CI 1.10 to 2.78) with greatest odds in PGY3 (OR 3.13, 95% CI 1.54 to 6.37). CONCLUSION Differences in ITE over training were associated with resident gender and race/ethnicity. Women and URiM residents had smaller ITE score gains across PGY translating into greater odds of potentially being seen as at-risk for not passing the ABIM-CE. Differences in ITE over training may reflect differences in experiences of women and URiM residents during training and may lead to further disparities.
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Affiliation(s)
- Robin Klein
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta, GA, 30303, USA.
| | - Jennifer Koch
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Erin D Snyder
- Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
| | - Wendy Simon
- Department of Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Simerjot K Jassal
- Department of Medicine, VA San Diego Healthcare System, University of California, San Diego, San Diego, USA
| | - Dominique Cosco
- Department of Medicine, Washington University St. Louis, St. Louis, USA
| | - Anne Cioletti
- Department of Medicine, University of Utah, Salt Lake City, USA
| | - Nneka N Ufere
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Schaeffer
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine A Julian
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vanessa Thompson
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Velin L, Chew MS, Pompermaier L. Discrimination in an "equal country"-a survey amongst Swedish final-year medical students. BMC MEDICAL EDUCATION 2022; 22:503. [PMID: 35761244 PMCID: PMC9238226 DOI: 10.1186/s12909-022-03558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden. METHODS A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher's exact test, and logistic regression. Free-text answers were analyzed thematically using the "Master Suppression techniques" conceptual framework. RESULTS Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported "large" or "extreme" impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001). CONCLUSIONS Discrimination appears to be frequent in medical school, even in one of the world's "most equal countries". Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.
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Affiliation(s)
- Lotta Velin
- Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Johannes Magnus väg 11, 583 30, Linköping, Sweden.
| | - Michelle S Chew
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- ANOPIVA US, Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Linköping, Sweden
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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80
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Esparza CJ, Simon M, Bath E, Ko M. Doing the Work-or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers. Front Public Health 2022; 10:900283. [PMID: 35812485 PMCID: PMC9256912 DOI: 10.3389/fpubh.2022.900283] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/26/2022] [Indexed: 12/26/2022] Open
Abstract
While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.
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Affiliation(s)
- Caitlin Jade Esparza
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Mark Simon
- Storywalkers Consulting, Davis, CA, United States
| | - Eraka Bath
- The Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle Ko
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
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81
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Milam AJ, Brown I, Edwards-Johnson J, McDougle L, Sousa A, Furr-Holden D. Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:876-883. [PMID: 35703911 PMCID: PMC9204755 DOI: 10.1097/acm.0000000000004638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. METHOD This study collected data from a convenience sample of Black U.S. medical students via an anonymous electronic questionnaire in August 2020 that was distributed through the Student National Medical Association and Organization of Student Representatives listservs and an author's social media accounts. It included questions on demographics, institutional responses to seminal race events, experiences of discrimination, and symptoms of depression. Path models were used to examine the relationship between experiences of discrimination, institutional responses to seminal race events, and depressive symptoms among Black medical students. RESULTS Of the 750 students completing the survey, 733 (97.7%) were Black. Experiences of discrimination and a lack of institutional responses to seminal race events were associated with more depressive symptoms (b = 0.19, 95% CI: 0.11, 0.26; P < .001 and b = 0.12, 95% CI: 0.04, 0.20; P = .01). After controlling for gender and clinical diagnosis of depression or anxiety before medical school, there was a relationship between experiences of discrimination and institutional responses to seminal race events such that students who reported more experiences of discrimination were more likely to report that their institution did not respond to seminal race events (b = 0.41, 95% CI: 0.34, 0.48; P < .001). Experiences of discrimination moderated the relationship between institutional responses to seminal race events and depressive symptoms (i.e., the relationship between a lack of institutional responses to seminal race events and depressive symptoms was stronger among students who reported more frequent experiences of discrimination). CONCLUSIONS Institutions dedicated to supporting Black medical student wellness must be diligent in cultivating a culture intolerant of discrimination and deft in their responses to seminal race events in the larger culture.
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Affiliation(s)
- Adam J Milam
- A.J. Milam is associate professor of anesthesiology, Mayo Clinic, Phoenix, Arizona; ORCID: https://orcid.org/0000-0001-9306-1598
| | - Italo Brown
- I. Brown is assistant professor of emergency medicine, Stanford University School of Medicine, Stanford, California
| | - Jennifer Edwards-Johnson
- J. Edwards-Johnson is associate professor and community assistant dean, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Leon McDougle
- L. McDougle is professor of family medicine and associate dean for diversity and inclusion, The Ohio State University College of Medicine, Columbus, Ohio; ORCID: https://orcid.org/0000-0003-2400-8763
| | - Aron Sousa
- A. Sousa is interim dean, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Debra Furr-Holden
- D. Furr-Holden is the C.S. Mott Endowed Professor of Public Health and associate dean for public health integration, College of Human Medicine, Michigan State University, East Lansing, Michigan; ORCID: https://orcid.org/0000-0002-9337-9886
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Forrest LL, Geraghty JR. Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:781-785. [PMID: 35234719 DOI: 10.1097/acm.0000000000004644] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Trainees' value as effective leaders within academic medicine has been increasingly recognized. From their perspective as adult learners who enter medical education from diverse backgrounds, trainees offer significant value to the teaching, learning, and practice of medicine. As such, trainees have developed and led various successful initiatives throughout academic medicine. In this Invited Commentary, 2 medical students with national leadership roles provide their perspectives on how student-led initiatives and advocacy can help push academic medicine forward. The authors first provide an overview of the success of student-led initiatives throughout medical education as evidenced by the Trainee-Authored Letters to the Editor in this issue, highlighting the unique contributions and perspectives of trainees in the development and implementation of new initiatives or ways of thinking. Although trainees add value to many areas in academic medicine, here the authors highlight 4 current areas that align with Association of American Medical Colleges priorities: (1) public health emergencies including the COVID-19 pandemic; (2) equity, inclusion, and diversity; (3) wellness and resilience amongst trainees and health care providers; and (4) recent changes to the United States Medical Licensing Examination and the transition to residency. By sharing their experiences with student-led initiatives within each of these domains, the authors provide lessons learned and discuss successes and obstacles encountered along the way. Overall, there is a critical need for increased engagement of trainees in medical education. Empowering trainees now ensures the academic medicine leaders of tomorrow are prepared to face the challenges that await them.
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Affiliation(s)
- Lala L Forrest
- L.L. Forrest is a third-year medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Joseph R Geraghty
- J.R. Geraghty is a third-year medical student in the Medical Scientist Training Program (MSTP) at the University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-6828-4893
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Hsiang E, Ritchie AM, Lall MD, Driver L, Moll J, Sonn B, Totten VY, Williams DB, McGregor AJ, Egan DJ. Emergency care of LGBTQIA+ patients requires more than understanding the acronym. AEM EDUCATION AND TRAINING 2022; 6:S52-S56. [PMID: 35783082 PMCID: PMC9222885 DOI: 10.1002/aet2.10750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/06/2021] [Accepted: 11/21/2021] [Indexed: 06/15/2023]
Abstract
Emergency physicians (EPs) frequently deliver care to members of the LGBTQIA+ community in the emergency department. This community suffers from many health disparities important to understand as part of comprehensive care, and these disparities are infrequently discussed in emergency medicine education. Previous data also suggest a need for broader education to increase the comfort of EPs caring for LGBTQIA+ patients. A group of content experts identified key disparities, opportunities for expanded education, and strategies for more inclusive care of LGBTQIA+ patients.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | | | | | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
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Zárate Rodriguez JG, Gan CY, Williams GA, Drake TO, Ciesielski T, Sanford DE, Awad MM. Applicants' perception of fit to residency programmes in the video-interview era: A large multidisciplinary survey. MEDICAL EDUCATION 2022; 56:641-650. [PMID: 35014076 DOI: 10.1111/medu.14729] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION 'Fit' refers to an applicants' perceived compatibility to a residency programme. A variety of structural, identity-related and relational factors contribute to self-assessments of fit. The 2021 residency recruitment cycle in the USA was performed virtually due to the COVID-19 pandemic. Little is known about how video-interviewing may affect residency applicants' ability to gauge fit. METHODS A multidisciplinary, anonymous survey was distributed to applicants at a large academic institution between rank order list (ROL) certification deadline and Match Day 2021. Using Likert-type scales, applicants rated factors for importance to 'fit' and their ease of assessment through video-interviewing. Applicants also self-assigned fit scores to the top-ranked programme in their ROL using Likert-type scales with pairs of anchoring statements. RESULTS Four hundred seventy-three applicants responded to the survey (25.7% response rate). The three most important factors to applicants for assessment of fit (how much the programme seemed to care, how satisfied residents seem with their programme and how well the residents get along) were also the factors with the greatest discrepancy between importance and ease of assessment through video-interviewing. Diversity-related factors were more important to female applicants compared with males and to non-White applicants compared with White applicants. Furthermore, White male applicants self-assigned higher fit scores compared with other demographic groups. CONCLUSION There is a marked discrepancy between the most important factors to applicants for fit and their ability to assess those factors virtually. Minoritised trainees self-assigned lower fit scores to their top-ranked programme, which should raise concern amongst medical educators and highlights the importance of expanding current diversity, equity and inclusion efforts in academic medicine.
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Affiliation(s)
- Jorge G Zárate Rodriguez
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Connie Y Gan
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Gregory A Williams
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Tia O Drake
- Graduate Medical Education, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Thomas Ciesielski
- Graduate Medical Education, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Dominic E Sanford
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Michael M Awad
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Increasing LGBTQ+ Visibility and Representation in Ophthalmology: A Professional Imperative. Am J Ophthalmol 2022; 242:A4-A6. [PMID: 35594915 DOI: 10.1016/j.ajo.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 11/20/2022]
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Marr MC, Heffron AS, Kwan JM. Characteristics, barriers, and career intentions of a national cohort of LGBTQ+ MD/PhD and DO/PhD trainees. BMC MEDICAL EDUCATION 2022; 22:304. [PMID: 35449040 PMCID: PMC9027045 DOI: 10.1186/s12909-022-03378-8] [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: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, non-binary, intersex, and/or asexual (LGBTQ+) individuals continue to suffer worse health outcomes compared to the general population. Data on LGBTQ+ individuals in medicine, particularly in medical training, remain sparse. National studies of LGBTQ+ students in MD/PhD and DO/PhD training programs have not been reported. METHODS Trainees pursuing MD, DO, MD/PhD, and DO/PhD degrees at 32 nationally representative institutions completed a 70-item survey about their future career and anticipated challenges using an online survey tool from September 2012 to December 2014. There were 4,433 respondents to the survey. Of those, 2,837 completed the gender identity questions and 2,849 completed the sexual orientation questions. Completion of these questions was required for inclusion. Survey results were analyzed to examine differences between LGBTQ+ and non-LGBTQ+ medical and dual degree trainees. RESULTS LGBTQ+ students were underrepresented among MD/PhD and DO/PhD trainees (8.70%) compared to the US population, though their representation was higher than among MD and DO trainees (5.20%). LGBTQ+ dual degree trainees endorsed the greatest interest in pursuing careers involving academic medicine, with varying career focuses including research, clinical duties, education, and advocacy. LGBTQ+ dual degree trainees prioritized opportunities in patient care, work-life balance, and research as the most important factors for their career selection. Importantly, a higher percentage of LGBTQ+ dual degree trainees (15.50%) identified sexual harassment as a past barrier to career advancement compared to their non-LGBTQ+ peers (8.27%). LGBTQ+ dual degree trainees were more likely to report having a mentor who advocated for them. CONCLUSIONS LGBTQ+ physician scientist trainees remain under-represented and under-studied. It is vital that medical institutions devote more time and resources towards identifying and addressing the unique needs of this group in training. Training programs should be aware of the current and prior challenges faced by their LGBTQ+ dual degree trainees, work to overcome the unique barriers they face, highlight the strengths and unique perspectives they bring, and foster their professional growth and goals during and beyond their training.
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Affiliation(s)
- Mollie C Marr
- Oregon Health & Science University Medical Scientist Training Program, Portland, OR, USA
| | - Anna S Heffron
- University of Wisconsin School of Medicine and Public Health Medical Scientist Training Program, Madison, WI, USA
| | - Jennifer M Kwan
- Yale School of Medicine in New Haven, New Haven, CT, 06520, USA.
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Jaber Chehayeb R, SenthilKumar G, Saade Z, Gallo Marin B, Aghagoli G, Virji AZ. Examining the First Peer-to-Peer Mentorship Program (F1Doctors) for International Medical Students. JOURNAL OF INTERDISCIPLINARY STUDIES IN EDUCATION 2022; 11:102-125. [PMID: 36405890 PMCID: PMC9673072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this study, we report international medical students in the United States and conduct an analysis of the first, peer-to-peer, national mentorship program for international medical students and international pre-med applicants in the US (F1Doctors). We used analyzed survey data collected through F1Doctors and the Association of American Medical Colleges yearly matriculation reports. Results indicated that the average college grade point average (GPA) and Medical College Admission Test score (MCAT) of international applicants was higher than that of all applicants. Additionally, non-US applicants reported facing numerous unique challenges such as limited access to extracurricular opportunities and difficulty finding mentors who are familiar with the application process. International applicants have the potential to increase the diversity of healthcare professionals, and F1Doctors is the first platform to support international healthcare applicants in the US.
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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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Bod J, Boatright D. Implementation of a Diversity Committee to Improve Structural Inclusion in an Emergency Medicine Residency. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2022; 10:126-130. [PMID: 35434152 PMCID: PMC9005756 DOI: 10.30476/jamp.2021.93492.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To describe structural changes that can be made in an emergency medicine residency program to increase diversity and foster an inclusive environment. METHODS We established a diversity committee to introduce several simultaneous structural changes focusing on resident recruitment, education and engagement. Some of these changes include establishment of a scholarship to recruit visiting students from diverse backgrounds and a second look weekend for minority applicants. Others focused on ensuring residency didactics, were inclusive and addressed topics pertaining to diversity in emergency medicine. RESULTS We increased the number of minority residents underrepresented in medicine matching in our program from zero to between 2 and 4 annually. We increased the percentage of women matching in our program from 33% to 47%. We worked with residency leadership to increase the number of didactics focusing on diversity and inclusion. CONCLUSIONS Implementation of a Diversity Committee in emergency medicine training programs can be an important tool to improve diversity on a structural level.
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Affiliation(s)
- Jessica Bod
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT, USA
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Ryus CR, Samuels EA, Wong AH, Hill KA, Huot S, Boatright D. Burnout and Perception of Medical School Learning Environments Among Gay, Lesbian, and Bisexual Medical Students. JAMA Netw Open 2022; 5:e229596. [PMID: 35486396 PMCID: PMC9055452 DOI: 10.1001/jamanetworkopen.2022.9596] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. OBJECTIVE To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. EXPOSURES Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. MAIN OUTCOMES AND MEASURES Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. RESULTS A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. CONCLUSIONS AND RELEVANCE In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.
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Affiliation(s)
- Caitlin R. Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Stephen Huot
- Office of Graduate Medical Education, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Teshome BG, Desai MM, Gross CP, Hill KA, Li F, Samuels EA, Wong AH, Xu Y, Boatright DH. Marginalized identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study. BMJ 2022; 376:e065984. [PMID: 35318190 PMCID: PMC8938931 DOI: 10.1136/bmj-2021-065984] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education. DESIGN Cross sectional survey and retrospective cohort study. SETTING 140 US medical schools accredited by the Association of American Medical Colleges. PARTICIPANTS 30 651 graduating medical students in 2016 and 2017. MAIN OUTCOME MEASURES Self-reported sex, race or ethnicity, and sexual orientation groups were considered, based on the unique combinations of historically marginalized identities held by students. Multivariable linear regression was used to determine the association between unique identity groups and burnout along two dimensions (exhaustion and disengagement) as measured by the Oldenburg Burnout Inventory for Medical Students while accounting for mistreatment and discrimination. RESULTS Students with three marginalized identities (female; non-white; lesbian, gay, or bisexual (LGB)) had the largest proportion reporting recurrent experiences of multiple types of mistreatment (88/299, P<0.001) and discrimination (92/299, P<0.001). Students with a higher number of marginalized identities also had higher average scores for exhaustion. Female, non-white, and LGB students had the largest difference in average exhaustion score compared with male, white, and heterosexual students (adjusted mean difference 1.96, 95% confidence interval 1.47 to 2.44). Mistreatment and discrimination mediated exhaustion scores for all identity groups but did not fully explain the association between unique identity group and burnout. Non-white and LGB students had higher average disengagement scores than their white and heterosexual counterparts (0.28, 0.19 to 0.37; and 0.73, 0.52 to 0.94; respectively). Female students, in contrast, had lower average disengagement scores irrespective of the other identities they held. After adjusting for mistreatment and discrimination among female students, the effect among female students became larger, indicating a negative confounding association. CONCLUSION In this study population of US medical students, those with multiple marginalized identities reported more mistreatment and discrimination during medical school, which appeared to be associated with burnout.
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Affiliation(s)
- Bethelehem G Teshome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Associate Dean for Diversity, Equity, and Inclusion, Yale School of Public Health, New Haven, CT, USA
| | - Cary P Gross
- Department of Internal Medicine, National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | | | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yunshan Xu
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Dowin H Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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Underrepresented in medicine: Making surgical training anti-racist. Am J Surg 2022; 224:302-306. [DOI: 10.1016/j.amjsurg.2022.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/25/2023]
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Naidoo K, Plummer L, McKean M, Mack A, Bowdle GK, Mullins MA, Gore S. Virtual Faculty and Peer Mentoring to Promote Social Belonging among Minoritized Physical Therapist and Nursing Students. Healthcare (Basel) 2022; 10:healthcare10030416. [PMID: 35326893 PMCID: PMC8948746 DOI: 10.3390/healthcare10030416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Minoritized health sciences students report experiencing social isolation and discrimination, and cite the lack of faculty representation as barriers to their success. While virtual mentoring can increase sense of belonging and connectedness, these effects have not been examined in minoritized health sciences students. The purpose of this study was to investigate whether virtual mentoring from faculty and peers could decrease social isolation and promote social belonging among minoritized first-year physical therapy and nursing students. Using a mixed methods explanatory sequential design, racial and ethnic minority physical therapy and nursing students (n = 8) received virtual mentoring and attended virtual networking events while students from across the health profession programs served as a comparison group (n = 16). While virtual mentoring relationships took longer to establish, there was an increase in satisfaction with mentoring for the intervention group compared with no improvement for the comparison group who received traditional academic advising. Qualitative data analysis revealed that mentors served as role models who had overcome barriers and persevered, decreasing feelings of isolation, and bolstering mentee confidence. A virtual multiple-mentor model can decrease isolation and promote social belonging for minoritized students and offer support for students even after the pandemic.
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Anderson N, Lett E, Asabor EN, Hernandez AL, Nguemeni Tiako MJ, Johnson C, Montenegro RE, Rizzo TM, Latimore D, Nunez-Smith M, Boatright D. The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students. J Gen Intern Med 2022; 37:298-307. [PMID: 33939079 PMCID: PMC8811096 DOI: 10.1007/s11606-021-06786-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS We conducted a cross-sectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1.48-11.05), and 9.38 (95% CI: 3.71-26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.
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Affiliation(s)
- Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Elle Lett
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Tara M Rizzo
- Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marcella Nunez-Smith
- Department of Internal Medicine and the Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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95
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Hatfield M, Ciaburri R, Shaikh H, Wilkins KM, Bjorkman K, Goldenberg M, McCollum S, Shabanova V, Weiss P. Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event. Hosp Pediatr 2022; 12:181-190. [PMID: 35102377 DOI: 10.1542/hpeds.2021-006267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.
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Affiliation(s)
| | | | - Henna Shaikh
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | | | - Kurt Bjorkman
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | | | - Sarah McCollum
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Pnina Weiss
- Pediatrics, Yale School of Medicine, New Haven, Connecticut
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96
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O’Marr JM, Chan SM, Crawford L, Wong AH, Samuels E, Boatright D. Perceptions on Burnout and the Medical School Learning Environment of Medical Students Who Are Underrepresented in Medicine. JAMA Netw Open 2022; 5:e220115. [PMID: 35195698 PMCID: PMC8867243 DOI: 10.1001/jamanetworkopen.2022.0115] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Burnout is a highly prevalent issue among medical trainees, but there has been limited research characterizing burnout specifically among medical students from groups who are underrepresented in medicine (URIM). OBJECTIVE To assess the association between components of the medical school learning environment and burnout among medical students who are URIM vs those who are not. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional survey study evaluated responses of allopathic medical students graduating from all US allopathic medical schools in 2016 and 2017 to the American Medical Colleges Graduation Questionnaire. Analysis was completed between December 1, 2019, and July 1, 2020. EXPOSURES Self-identification as a medical student who is URIM. MAIN OUTCOMES AND MEASURES Self-reported measures of medical student overall, disengagement, and exhaustion-related burnout using the Oldenburg Burnout Inventory for Medical Students. RESULTS The American Medical Colleges Graduation Questionnaire had an 81% response rate, yielding 26 567 complete participant responses that were included the analysis. A total of 13 645 individuals (51.4%) were male, and 3947 (14.9%) identified as URIM (ie, Alaska Native, Black, Hispanic/Latinx, Native American, and/or Pacific Islander). Medical students who are URIM reported modestly higher levels of exhaustion-related burnout (mean [SD], 11.84 [3.62] vs 11.48 [3.61]; P < .001) and modestly lower mean burnout scores associated with disengagement (mean [SD], 9.24 [3.56] vs 9.36 [3.58]; P = .047). Medical students who are URIM also reported marginally less favorable student-faculty interactions in the learning environment (mean [SD], 14.09 [3.45] vs 14.29 [3.35]; P < .001). Medical students who are URIM were more likely to be in the top quartile of those who experienced exhaustion-related burnout (odds ratio, 1.19 [95% CI, 1.09-1.29]) but less likely to be in the top quartile for disengagement (odds ratio, 0.87 [95% CI, 0.80-0.94]). Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination. CONCLUSIONS AND RELEVANCE This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout. This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility, and/or recurrent discrimination. The learning environment can play a key role in mitigating burnout in both medical students who are URIM and those who are not and is deserving of further research.
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Affiliation(s)
| | | | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dowin Boatright
- Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Marquardt D, Langdale L, Kim S, Leroux B, Friedrich J, Schreuder AB, Wood DE. Closing the gap: Triangulation of surgeons’ respectful behaviors perceived by medical students, residents, and patients. Surgery 2022; 172:96-101. [DOI: 10.1016/j.surg.2021.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
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98
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Pagali SR, Kiliaki SA, Rizvi SA. Hospital medicine team perception of diversity and inclusion at work. Hosp Pract (1995) 2021; 49:376-378. [PMID: 34755581 DOI: 10.1080/21548331.2021.2003672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND : Diversity and Inclusion concepts are crucial in healthcare as the patient population we encounter as hospitalist medicine team is diverse. A diverse and inclusive environment for healthcare employees can lead to improved job satisfaction and high-quality medical care of patients. However, hospitalist perspectives on diversity and inclusion in their work environment are not well studied and noted in literature. Understanding hospitalist perspectives of diversity and inclusion is important in promoting organizational culture. METHODS We conducted an online survey of a large hospitalist group at Mayo Clinic, Rochester, from October-December 2019, as part of Hospital Internal Medicine (HIM) Diversity Council (HIM-DC) inception, to understand the perceptions of its staff about diversity and inclusion at work and facilitate the next best steps for the team. The responses to the survey questions were graded on a likert scale. Descriptive statistics were used to analyze and interpret the data. RESULTS : Of the 135 team members, 78 responded (58%). Of the respondents, more than 80% never witnessed or experienced discrimination from a colleague, while more than 50% did witness or experience discrimination from a patient/visitor. More than 70% did not report this discrimination. Nearly 90% felt that it was an inclusive environment at work, across different personal attributes. Most of the respondents requested additional cultural education and social events. CONCLUSION Unfortunately, a higher percentage of discrimination is perceived from patients/visitors. This highlights the need for institutional policies about visitor conduct. A high proportion of HIM staff felt inclusive at workplace. Committees such as HIM-DC can augment cultural education and social events to improve team's perception.
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Affiliation(s)
- Sandeep R Pagali
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shangwe A Kiliaki
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Syed Ahsan Rizvi
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Madrigal J, Rudasill S, Tran Z, Bergman J, Benharash P. Sexual and gender minority identity in undergraduate medical education: Impact on experience and career trajectory. PLoS One 2021; 16:e0260387. [PMID: 34797881 PMCID: PMC8604342 DOI: 10.1371/journal.pone.0260387] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The wellbeing of sexual and gender minority (SGM) medical students and the impact of their experiences on career trajectory remain poorly understood. The present study aimed to characterize the incidence of mistreatment in SGM trainees as well as general perspectives on the acceptance of SGM individuals across medical and surgical specialties. METHODS This was a cross sectional survey study of all actively enrolled medical students within the six University of California campuses conducted in March 2021. An online, survey tool captured incidence of bullying, discrimination, and suicidal ideation as well as perceived acceptance of SGM identities across specialties measured by slider scale. Differences between SGM and non-SGM respondents were assessed with two-tailed and chi-square tests. Qualitative responses were evaluated utilizing a multi-stage, cutting-and-sorting technique. RESULTS Of approximately 3,205 students eligible for participation, 383 submitted completed surveys, representing a response rate of 12.0%. Of these respondents, 26.9% (n = 103) identified as a sexual or gender minority. Overall, SGM trainees reported higher slider scale scores when asked about being bullied by other students (20.0 vs. 13.9, P = 0.012) and contemplating suicide (14.8 vs. 8.8, P = 0.005). Compared to all other specialties, general surgery and surgical subspecialties had the lowest mean slider scale score (52.8) in perceived acceptance of SGM identities (All P < 0.001). In qualitative responses, students frequently cited lack of diversity as contributing to this perception. Additionally, 67.0% of SGM students had concerns that disclosure of identity would affect their future career with 18.5% planning to not disclose during the residency application process. CONCLUSIONS Overall, SGM respondents reported higher incidences of bullying and suicidal ideation as well as increased self-censorship stemming from concerns regarding career advancement, most prominently in surgery. To address such barriers, institutions must actively promote diversity in sexual preference and gender identity regardless of specialty.
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Affiliation(s)
- Josef Madrigal
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Sarah Rudasill
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Jonathan Bergman
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- * E-mail:
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100
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Bissell BD, Johnston JP, Smith RR, Newsome AS, Thompson Bastin ML, Abdul-Mutakabbir J, Barlow A, Barlow B, Berger K, Crow JR, Dixit D, Jacobi J, Karaoui LR, Kiser TH, Kolesar J, Koontz SE, Mattingly TJ, Mitchell C, Nilges A, Rech MA, Heavner MS. Gender inequity and sexual harassment in the pharmacy profession: Evidence and call to action. Am J Health Syst Pharm 2021; 78:2059-2076. [PMID: 34232286 PMCID: PMC8344711 DOI: 10.1093/ajhp/zxab275] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Jackie P Johnston
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Rebecca R Smith
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | - Ashley Barlow
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Karen Berger
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Jessica R Crow
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Deepali Dixit
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | | | - Lamis R Karaoui
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jill Kolesar
- College of Pharmacy, University of Kentucky, Lexington KY, USA
| | | | - T Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | | | - Megan A Rech
- Department of Emergency Medicine, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, and Loyola University Medical Center, Maywood, IL, USA
| | - Mojdeh S Heavner
- Department of Pharmacy Practice and Sciences, University of Maryland School of Pharmacy, Baltimore, MD, USA
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