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Perceived Discrimination, Harassment, and Abuse in Physician Assistant Education: A Pilot Study. J Physician Assist Educ 2019; 29:77-85. [PMID: 29727429 DOI: 10.1097/jpa.0000000000000192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A 2014 meta-analysis found that by graduation, 16.6% of medical students had reported abuse, harassment, or discrimination and that this hostile environment caused an increase in depression and anxiety. The purpose of this research study was to increase the understanding of discrimination and psychological/physical abuse in physician assistant (PA) education programs and the potential impact on student attrition. METHODS Information was collected using an online, anonymous survey that asked about witnessed or experienced discrimination and psychological or physical abuse during the didactic and clinical years of training in PA programs in the United States. RESULTS The survey received 1159 respondents, which represents 6.1% of total PA student enrollment. Up to 30% of respondents had witnessed or experienced discrimination, and up to 2.3% had experienced psychological abuse while in PA school. The majority of witnessed or experienced discrimination during PA education was not reported (<2%). Reports were not made because students feared retribution or they simply did not know who to report to, particularly if the incident involved faculty. CONCLUSION Reducing the prevalence of discrimination in PA education requires recognition of this issue and targeted efforts to ensure that the infrastructure of every program is inclusive and values diversity of all kinds. The authors advocate that PA programs discuss their current institutional reporting structure; develop a universal curriculum on workplace violence, discrimination, and harassment; and develop value statements that explicitly identify diversity and equity as a core value as an important first step to improving the overall "climate" and culture of the program.
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102
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Low D, Pollack SW, Liao ZC, Maestas R, Kirven LE, Eacker AM, Morales LS. Racial/Ethnic Disparities in Clinical Grading in Medical School. TEACHING AND LEARNING IN MEDICINE 2019; 31:487-496. [PMID: 31032666 DOI: 10.1080/10401334.2019.1597724] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Phenomenon: Performance during the clinical phase of medical school is associated with membership in the Alpha Omega Alpha Honor Medical Society, competitiveness for highly selective residency specialties, and career advancement. Although race/ethnicity has been found to be associated with clinical grades during medical school, it remains unclear whether other factors such as performance on standardized tests account for racial/ethnic differences in clinical grades. Identifying the root causes of grading disparities during the clinical phase of medical school is important because of its long-term impacts on the career advancement of students of color. Approach: To evaluate the association between race/ethnicity and clinical grading, we examined Medical Student Performance Evaluation (MSPE) summary words (Outstanding, Excellent, Very Good, Good) and 3rd-year clerkship grades among medical students at the University of Washington School of Medicine. The analysis included data from July 2010 to June 2015. Medical students were categorized as White, underrepresented minorities (URM), and non-URM minorities. Associations between MSPE summary words and clerkship grades with race/ethnicity were assessed using ordinal logistic regression models. Findings: Students who identified as White or female, students who were younger in age, and students with higher United States Medical Licensing Examination Step 1 scores or final clerkship written exam scores consistently received higher final clerkship grades. Non-URM minority students were more likely than White students (Adjusted Odds Ratio = 0.53), confidence interval [0.36, 0.76], p = .001, to receive a lower category MSPE summary word in analyses adjusting for student demographics (age, gender, maternal education), year, and United States Medical Licensing Examination Step 1 scores. Similarly, in four of six required clerkships, grading disparities (p < .05) were found to favor White students over either URM or non-URM minority students. In all analyses, after accounting for all available confounding variables, grading disparities favored White students. Insights: This single institution study is among the first to document racial/ethnic disparities in MSPE summary words and clerkship grades while accounting for clinical clerkship final written examinations. A national focus on grading disparities in medical school is needed to understand the scope of this problem and to identify causes and possible remedies.
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Affiliation(s)
- Daniel Low
- Swedish Cherry Hill Family Medicine Residency, University of Washington School of Medicine, Seattle, Washington, WA, USA
| | - Samantha W Pollack
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Zachary C Liao
- Jackson Memorial Hospital, Internal Medicine Residency, University of Miami, Miami, FL, USA
| | - Ramoncita Maestas
- Student Affairs, University of Washington School of Medicine, Seattle, Washington, USA
| | - Larry E Kirven
- Wyoming WWAMI Program, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anne M Eacker
- Kaiser Permanente School of Medicine, Pasadena, California, USA
| | - Leo S Morales
- Center for Health Equity, Diversity, and Inclusion, University of Washington School of Medicine, Seattle, Washington, USA
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103
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Lai CJ, Jackson AV, Wheeler M, Dhaliwal G, Ziv TA, Kryzhanovskaya I, Teherani A. A framework to promote equity in clinical clerkships. CLINICAL TEACHER 2019; 17:298-304. [DOI: 10.1111/tct.13050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cindy J Lai
- Department of MedicineSchool of MedicineUniversity of California San Francisco California USA
| | - Andrea V Jackson
- Department of Obstetrics and GynecologySchool of MedicineUniversity of California San Francisco California USA
| | - Margaret Wheeler
- Department of MedicineSchool of MedicineUniversity of California San Francisco California USA
- Zuckerberg San Francisco General Hospital San Francisco California USA
| | - Gurpreet Dhaliwal
- Department of MedicineSchool of MedicineUniversity of California San Francisco California USA
- San Francisco Veterans Affairs Medical Center San Francisco California USA
| | - Tal Ann Ziv
- Department of MedicineSchool of MedicineUniversity of California San Francisco California USA
- Kaiser Permanente, East Bay Oakland California USA
| | - Irina Kryzhanovskaya
- Department of MedicineSchool of MedicineUniversity of California San Francisco California USA
| | - Arianne Teherani
- Department of MedicineSchool of MedicineUniversity of California San Francisco California USA
- Center for Faculty EducatorsSchool of MedicineUniversity of California San Francisco California USA
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Gamble Blakey A, Smith-Han K, Anderson L, Collins E, Berryman E, Wilkinson TJ. Interventions addressing student bullying in the clinical workplace: a narrative review. BMC MEDICAL EDUCATION 2019; 19:220. [PMID: 31226986 PMCID: PMC6588850 DOI: 10.1186/s12909-019-1578-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 04/25/2019] [Indexed: 05/12/2023]
Abstract
BACKGROUND Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research. METHODS We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes. RESULTS The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious. CONCLUSIONS Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).
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Affiliation(s)
| | - Kelby Smith-Han
- Otago Medical School, University of Otago, Dunedin, NZ New Zealand
| | - Lynley Anderson
- Bioethics Centre, University of Otago, Dunedin, NZ New Zealand
| | - Emma Collins
- Otago Polytechnic & Staff Nurse, Southern District Health Board, Dunedin, NZ New Zealand
| | - Elizabeth Berryman
- North Shore Hospital, Waitemata District Health Board, Auckland, NZ New Zealand
| | - Tim J. Wilkinson
- Otago Medical School, University of Otago, Dunedin, NZ New Zealand
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Alexander K, Cleland J, Nicholson S. Bridging the cultural divide? Exploring school pupils' perceptions of medicine. MEDICAL EDUCATION 2019; 53:571-583. [PMID: 30761588 DOI: 10.1111/medu.13805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 12/14/2018] [Indexed: 05/14/2023]
Abstract
CONTEXT Literature published around a decade ago demonstrated that UK individuals from non-traditional groups may not consider, or aspire to, medicine because of sociocultural barriers and instead may perceive medicine as 'not for the likes of me'. Since this time, the UK higher education landscape has undergone significant change, with an increased emphasis on student choice and widening access (WA) initiatives. Consequently, the present study looks anew at the perceptions of medicine held by school pupils from non-traditional backgrounds to assess whether sociocultural factors remain a major barrier to medicine. METHODS Focus groups were conducted with 71 high-achieving school pupils in their penultimate or final years (aged 16-18 years). Participants attended UK state-funded schools engaged with medical school WA initiatives. Transcripts were analysed thematically using a data-driven approach. Themes were then interpreted through the conceptual lens of the 'reflexive habitus', an adapted version of Bourdieu's classic concept. RESULTS Participants did not perceive that sociocultural differences would deter them from aspiring to, or pursuing, the career of their choice. Some participants identified their 'different' background as a strength to bring to medicine. They reported that intrinsic motivators (personal interest and fulfilment) were most important in their own career choices. When asked what they believed might have motivated current medical students for the career, participants debated the role of extrinsic motivators (high status and income) versus intrinsic ones. 'Hot knowledge' (social contacts) from within medicine helped some participants reconcile any clash in perceived values and better imagine themselves in the profession. CONCLUSIONS These non-traditional school pupils from schools engaged with WA initiatives appear to have embraced the belief that medicine is for anyone with the appropriate desire and ability, regardless of background. Furthermore, some pupils reported that some aspects of their 'difference' (diversity) could help enrich the workforce and patient care.
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Affiliation(s)
- Kirsty Alexander
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | - Sandra Nicholson
- Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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106
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Wyatt TR, Egan SC, Phillips C. The Resources We Bring: The Cultural Assets of Diverse Medical Students. THE JOURNAL OF MEDICAL HUMANITIES 2018; 39:503-514. [PMID: 30033480 DOI: 10.1007/s10912-018-9527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In response to the need for a more diverse workforce, our medical school developed new policies and procedures that focus on the recruitment and selection of diverse students with a specific focus on those considered underrepresented in medicine. To understand what these students bring to the practice of medicine, researchers investigated their perception of their cultural assets and how they plan to use these assets as physicians. A cross-section of 23 ethnically, culturally, and geographically diverse medical students were interviewed and data were analyzed through phenomenographical methods. The results indicate that students view themselves as having multiple assets that could be of significant value in their future practice of medicine, including: a) an interest in science and access to family members in medicine, b) personal and familial struggles with health, c) self and family as immigrants, and d) strong family and community orientations. Students perceived these as cultural assets because they could directly identify where these assets could be valuable in medicine but questioned how to maintain them throughout medical school. Now that our institution has identified these assets, next steps include administrators' investigation of ways to leverage them through curricular and educational programs.
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Affiliation(s)
- Tasha R Wyatt
- Educational Innovation Institute, Medical College of Georgia, Augusta University, 1120 15th Street, CJ 1020, Augusta, GA, 30809, USA.
| | - Sarah C Egan
- Educational Innovation Institute, Medical College of Georgia, Augusta University, 1120 15th Street, CJ 1020, Augusta, GA, 30809, USA
| | - Cole Phillips
- Medical College of Georgia, Augusta University, 1120 15th Street, CJ 1020, Augusta, GA, 30809, USA
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107
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Colford C, Kraemer MS, Contarino M, Denizard-Thompson N, Evans K, Hairston K, Harris R, McNeill D. After the Match: Cultivating a Community of Support, Retention, and Mentoring to Enhance Diversity. Am J Med 2018; 131:1520-1523. [PMID: 30076819 DOI: 10.1016/j.amjmed.2018.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/06/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Cristin Colford
- University of North Carolina School of Medicine, Chapel Hill.
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108
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Astfalk T, Müller-Hilke B. Same same but different - A qualitative study on the development and maintenance of personal networks among German and international medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2018; 35:Doc58. [PMID: 30637322 PMCID: PMC6326403 DOI: 10.3205/zma001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 05/05/2018] [Accepted: 06/05/2018] [Indexed: 06/09/2023]
Abstract
Introduction: In addition to linguistic and cultural difficulties, problems with social integration are frequently found among international medical students. In contrast, the social interaction among German medical students is considered as non-problematic. Personal networks are considered as positively influencing factors for the learning environment of students as well as their academic performance and personal wellbeing. However, while general findings on the development and maintenance of personal networks among medical students are available, there is insufficient data on students with different nationality or cultural backgrounds. Therefore, we compared the perception of international and German medical students on the development and maintenance of personal networks and examined possible influencing factors. Methodology: Following the principles of theoretical sampling in qualitative research, we recruited 17 international and 10 German preclinical medical students. The survey was conducted with semi-structured interviews, which focused on the participants' experiences with the development and maintenance of personal networks in medical school. The coding and analysis of the interview transcripts was based on the principles of grounded theory. Results: We show that German participants rated the network development in medical school much more positively than the international participants. This difference was influenced by: a different perception of affiliation to the group of medical students, a low academic benefit from contacts with international students, the socio-cultural framework of medical school as well as the individual strategies of international medical students in dealing with integration. Conclusion: Our study extends existing insights into the development and maintenance of the social environment in medical school by understanding the perception of a subgroup of medical students. A better understanding of these social processes enables an effective evaluation of support and teaching for the subgroup of international medical students in Germany.
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Affiliation(s)
- Timo Astfalk
- University Medical Center Rostock, Institute for Immunology, Research Group on Clinical Immunology, Rostock, Germany
| | - Brigitte Müller-Hilke
- University Medical Center Rostock, Institute for Immunology, Research Group on Clinical Immunology, Rostock, Germany
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109
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White BJ. African American nurses describe pre-licensure education experiences: A qualitative study. J Prof Nurs 2018; 34:346-351. [DOI: 10.1016/j.profnurs.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022]
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110
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Cleland J, Fahey Palma T. "Aspirations of people who come from state education are different": how language reflects social exclusion in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:513-531. [PMID: 29368073 DOI: 10.1007/s10459-018-9809-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/03/2018] [Indexed: 06/07/2023]
Abstract
Despite repeated calls for change, the problem of widening access (WA) to medicine persists globally. One factor which may be operating to maintain social exclusion is the language used in representing WA applicants and students by the gatekeepers and representatives of medical schools, Admissions Deans. We therefore examined the institutional discourse of UK Medical Admissions Deans in order to determine how values regarding WA are communicated and presented in this context. We conducted a linguistic analysis of qualitative interviews with Admissions Deans and/or Staff from 24 of 32 UK medical schools. Corpus Linguistics data analysis determined broad patterns of frequency and word lists. This informed a critical discourse analysis of the data using an "othering" lens to explore and understand the judgements made of WA students by Admissions Deans, and the practices to which these judgments give rise. Representations of WA students highlighted existing divides and preconceptions in relation to WA programmes and students. Through using discourse that can be considered othering and divisive, issues of social divide and lack of integration in medicine were highlighted. Language served to reinforce pre-existing stereotypes and a significant 'us' and 'them' rhetoric exists in medical education. Even with drivers to achieve diversity and equality in medical education, existing social structures and preconceptions still influence the representations of applicants and students from outside the 'traditional' medical education model in the UK. Acknowledging this is a crucial step for medical schools wishing to address barriers to the perceived challenges to diversity.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Tania Fahey Palma
- School of Language, Literature, Music and Visual Culture, University of Aberdeen, Taylor Building, Kings College, Aberdeen, AB24 3UB, UK
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111
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Acheampong C, Davis C, Holder D, Averett P, Savitt T, Campbell K. An Exploratory Study of Stress Coping and Resiliency of Black Men at One Medical School: A Critical Race Theory Perspective. J Racial Ethn Health Disparities 2018; 6:214-219. [DOI: 10.1007/s40615-018-0516-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 11/30/2022]
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112
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Youmans Q, Suleiman L. Finding Focus: Recruiting and Supporting Underrepresented Minority Trainees Starts With Faculty. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:523. [PMID: 29342002 DOI: 10.1097/acm.0000000000002134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Quentin Youmans
- Third-year internal medicine resident, Northwestern McGaw Medical Center, Chicago, Illinois; ; Twitter: @QuentinYoumans; ORCID: https://orcid.org/0000-0001-5818-8091. Fellow, Adult Hip and Knee Reconstruction, Rush University Medical Center, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-4448-0902
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113
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Fergus KB, Teale B, Sivapragasam M, Mesina O, Stergiopoulos E. Medical students are not blank slates: Positionality and curriculum interact to develop professional identity. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:5-7. [PMID: 29305819 PMCID: PMC5807268 DOI: 10.1007/s40037-017-0402-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Kirkpatrick B Fergus
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA.
| | - Bronte Teale
- School of Medicine, Western Sydney University-Campbelltown, Sydney, Australia
| | | | - Omar Mesina
- School of Medicine, University of California-San Francisco, San Francisco, CA, USA
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114
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Johnson DM, Lujan HL, DiCarlo SE. Whether we know it or not, our educational perceptions and decisions are shaped by "race". ADVANCES IN PHYSIOLOGY EDUCATION 2017; 41:565-568. [PMID: 29138213 DOI: 10.1152/advan.00107.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/11/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Donald M Johnson
- Wayne State University, School of Medicine, Detroit, Michigan; and
| | - Heidi L Lujan
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Stephen E DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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Karani R, Varpio L, May W, Horsley T, Chenault J, Miller KH, O'Brien B. Commentary: Racism and Bias in Health Professions Education: How Educators, Faculty Developers, and Researchers Can Make a Difference. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:S1-S6. [PMID: 29065016 DOI: 10.1097/acm.0000000000001928] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Research in Medical Education (RIME) Program Planning Committee is committed to advancing scholarship in and promoting dialogue about the critical issues of racism and bias in health professions education (HPE). From the call for studies focused on underrepresented learners and faculty in medicine to the invited 2016 RIME plenary address by Dr. Camara Jones, the committee strongly believes that dismantling racism is critical to the future of HPE.The evidence is glaring: Dramatic racial and ethnic health disparities persist in the United States, people of color remain deeply underrepresented in medical school and academic health systems as faculty, learner experiences across the medical education continuum are fraught with bias, and current approaches to teaching perpetuate stereotypes and insufficiently challenge structural inequities. To achieve racial justice in HPE, academic medicine must commit to leveraging positions of influence and contributing from these positions. In this Commentary, the authors consider three roles (educator, faculty developer, and researcher) represented by the community of scholars and pose potential research questions as well as suggestions for advancing educational research relevant to eliminating racism and bias in HPE.
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Affiliation(s)
- Reena Karani
- R. Karani is senior associate dean for undergraduate medical education and curricular affairs and professor of medical education, medicine and geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, New York, New York. L. Varpio is associate professor, Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland. W. May is director and professor, Clinical Skills Education and Evaluation Center, Keck School of Medicine of USC, Los Angeles, California. T. Horsley is associate director, Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada. J. Chenault is associate professor, Reference Department, Kornhauser Health Sciences Library, University of Louisville, Louisville, Kentucky. K.H. Miller is 2017 chair, Research in Medical Education Program Planning Committee, and associate professor of graduate medical education, University of Louisville School of Medicine, Louisville, Kentucky. B. O'Brien is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California
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116
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Dunham L, Dekhtyar M, Gruener G, CichoskiKelly E, Deitz J, Elliott D, Stuber ML, Skochelak SE. Medical Student Perceptions of the Learning Environment in Medical School Change as Students Transition to Clinical Training in Undergraduate Medical School. TEACHING AND LEARNING IN MEDICINE 2017; 29:383-391. [PMID: 28318319 DOI: 10.1080/10401334.2017.1297712] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
UNLABELLED Phenomenon: The learning environment is the physical, social, and psychological context in which a student learns. A supportive learning environment contributes to student well-being and enhances student empathy, professionalism, and academic success, whereas an unsupportive learning environment may lead to burnout, exhaustion, and cynicism. Student perceptions of the medical school learning environment may change over time and be associated with students' year of training and may differ significantly depending on the student's gender or race/ethnicity. Understanding the changes in perceptions of the learning environment related to student characteristics and year of training could inform interventions that facilitate positive experiences in undergraduate medical education. APPROACH The Medical School Learning Environment Survey (MSLES) was administered to 4,262 students who matriculated at one of 23 U.S. and Canadian medical schools in 2010 and 2011. Students completed the survey at the end of each year of medical school as part of a battery of surveys in the Learning Environment Study. A mixed-effects longitudinal model, t tests, Cohen's d effect size, and analysis of variance assessed the relationship between MSLES score, year of training, and demographic variables. FINDINGS After controlling for gender, race/ethnicity, and school, students reported worsening perceptions toward the medical school learning environment, with the worst perceptions in the 3rd year of medical school as students begin their clinical experiences, and some recovery in the 4th year after Match Day. The drop in MSLES scores associated with the transition to the clinical learning environment (-0.26 point drop in addition to yearly change, effect size = 0.52, p < .0001) is more than 3 times greater than the drop between the 1st and 2nd year (0.07 points, effect size = 0.14, p < .0001). The largest declines were from items related to work-life balance and informal student relationships. There was some, but not complete, recovery in perceptions of the medical school learning environment in the 4th year. Insights: Perceptions of the medical school learning environment worsen as students continue through medical school, with a stronger decline in perception scores as students' transition to the clinical learning environment. Students reported the greatest drop in finding time for outside activities and students helping one another in the 3rd year. Perceptions differed based on gender and race/ethnicity. Future studies should investigate the specific features of medical schools that contribute most significantly to student perceptions of the medical school learning environment, both positive and negative, to pinpoint potential interventions and improvements.
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Affiliation(s)
- Lisette Dunham
- a Medical Education Outcomes , American Medical Association , Chicago , Illinois , USA
| | - Michael Dekhtyar
- a Medical Education Outcomes , American Medical Association , Chicago , Illinois , USA
| | - Gregory Gruener
- b Department of Neurology , Loyola University Chicago Stritch School of Medicine , Maywood , Illinois , USA
| | - Eileen CichoskiKelly
- c Department of Family Medicine , University of Vermont Larner College of Medicine , Burlington , Vermont , USA
| | - Jennifer Deitz
- d Educational Programs and Services , Stanford University School of Medicine , Stanford , California , USA
| | - Donna Elliott
- e Department of Pediatrics , Keck School of Medicine of the University of Southern California , Los Angeles , California , USA
| | - Margaret L Stuber
- f Psychiatry and Biobehavioral Sciences , David Geffen School of Medicine at University of California, Los Angeles , Los Angeles , California , USA
| | - Susan E Skochelak
- g Medical Education , American Medical Association , Chicago , Illinois , USA
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Wikaire E, Curtis E, Cormack D, Jiang Y, McMillan L, Loto R, Reid P. Predictors of academic success for Māori, Pacific and non-Māori non-Pacific students in health professional education: a quantitative analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:299-326. [PMID: 28236125 DOI: 10.1007/s10459-017-9763-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
Tertiary institutions internationally aim to increase student diversity, however are struggling to achieve equitable academic outcomes for indigenous and ethnic minority students and detailed exploration of factors that impact on success is required. This study explored the predictive effect of admission variables on academic outcomes for health professional students by ethnic grouping. Kaupapa Māori and Pacific research methodologies were used to conduct a quantitative analysis using data for 2686 health professional students [150 Māori, 257 Pacific, 2279, non-Māori non-Pacific (nMnP)]. The predictive effect of admission variables: school decile; attending school in Auckland; type of admission; bridging programme; and first-year bachelor results on academic outcomes: year 2-4 grade point average (GPA); graduating; graduating in the minimum time; and optimal completion for the three ethnic groupings and the full cohort was explored using multiple regression analyses. After adjusting for admission variables, for every point increase in first year bachelor GPA: year 2-4 GPA increased by an average of 0.46 points for Māori (p = 0.0002, 95% CI 0.22, 0.69), 0.70 points for Pacific (p < 0.0001, CI 0.52, 0.87), and 0.55 points for nMnP (p < 0.0001, CI 0.51, 0.58) students. For the total cohort, ethnic grouping was consistently the most significant predictor of academic outcomes. This study demonstrated clear differences in academic outcomes between both Māori and Pacific students when compared to nMnP students. Some (but not all) of the disparities between ethnic groupings could be explained by controlling for admission variables.
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Affiliation(s)
- Erena Wikaire
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Elana Curtis
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Donna Cormack
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Louise McMillan
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Rob Loto
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori (Department of Māori Health), Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Kosobuski AW, Whitney A, Skildum A, Prunuske A. Development of an interdisciplinary pre-matriculation program designed to promote medical students' self efficacy. MEDICAL EDUCATION ONLINE 2017; 22:1272835. [PMID: 28178916 PMCID: PMC5328374 DOI: 10.1080/10872981.2017.1272835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND AND OBJECTIVES A four-week interdisciplinary pre-matriculation program for Native American and rural medical students was created and its impact on students' transition to medical school was assessed. The program extends the goals of many pre-matriculation programs by aiming to increase not only students' understanding of basic science knowledge, but also to build student self-efficacy through practice with medical school curricular elements while developing their academic support networks. DESIGN A mixed method evaluation was used to determine whether the goals of the program were achieved (n = 22). Student knowledge gains and retention of the microbiology content were assessed using a microbiology concept inventory. Students participated in focus groups to identify the benefits of participating in the program as well as the key components of the program that benefitted the students. RESULTS Program participants showed retention of microbiology content and increased confidence about the overall medical school experience after participating in the summer program. CONCLUSIONS By nurturing self-efficacy, participation in a pre-matriculation program supported medical students from Native American and rural backgrounds during their transition to medical school. ABBREVIATIONS CAIMH: Center of American Indian and Minority Health; MCAT: Medical College Admission Test; PBL: Problem based learning; UM MSD: University of Minnesota Medical School Duluth.
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Affiliation(s)
- Anna Wirta Kosobuski
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | | | - Andrew Skildum
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Amy Prunuske
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
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Wikaire E, Curtis E, Cormack D, Jiang Y, McMillan L, Loto R, Reid P. Patterns of privilege: A total cohort analysis of admission and academic outcomes for Māori, Pacific and non-Māori non-Pacific health professional students. BMC MEDICAL EDUCATION 2016; 16:262. [PMID: 27717348 PMCID: PMC5054619 DOI: 10.1186/s12909-016-0782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Tertiary institutions are struggling to ensure equitable academic outcomes for indigenous and ethnic minority students in health professional study. This demonstrates disadvantaging of ethnic minority student groups (whereby Indigenous and ethnic minority students consistently achieve academic outcomes at a lower level when compared to non-ethnic minority students) whilst privileging non-ethnic minority students and has important implications for health workforce and health equity priorities. Understanding the reasons for academic inequities is important to improve institutional performance. This study explores factors that impact on academic success for health professional students by ethnic group. METHODS Kaupapa Māori methodology was used to analyse data for 2686 health professional students at the University of Auckland in 2002-2012. Data were summarised for admission variables: school decile, Rank Score, subject credits, Auckland school, type of admission, and bridging programme; and academic outcomes: first-year grade point average (GPA), first-year passed all courses, year 2 - 4 programme GPA, graduated, graduated in the minimum time, and composite completion for Māori, Pacific, and non-Māori non-Pacific (nMnP) students. Statistical tests were used to identify significant differences between the three ethnic groupings. RESULTS Māori and Pacific students were more likely to attend low decile schools (27 % Māori, 33 % Pacific vs. 5 % nMnP, p < 0.01); complete bridging foundation programmes (43 % Māori, 50 % Pacific vs. 5 % nMnP, p < 0.01), and received lower secondary school results (Rank Score 197 Māori, 178 Pacific vs. 231 nMnP, p < 0.01) when compared with nMnP students. Patterns of privilege were seen across all academic outcomes, whereby nMnP students achieved higher first year GPA (3.6 Māori, 2.8 Pacific vs. 4.7 nMnP, p < 0.01); were more likely to pass all first year courses (61 % Māori, 41 % Pacific vs. 78 % nMnP, p < 0.01); to graduate from intended programme (66 % Māori, 69 % Pacific vs. 78 % nMnP, p < 0.01); and to achieve optimal completion (9 % Māori, 2 % Pacific vs. 20 % nMnP, p < 0.01) when compared to Māori and Pacific students. CONCLUSIONS To meet health workforce and health equity goals, tertiary institution staff should understand the realities and challenges faced by Māori and Pacific students and ensure programme delivery meets the unique needs of these students. Ethnic disparities in academic outcomes show patterns of privilege and should be alarming to tertiary institutions. If institutions are serious about achieving equitable outcomes for Māori and Pacific students, major institutional changes are necessary that ensure the unique needs of Māori and Pacific students are met.
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Affiliation(s)
- Erena Wikaire
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand
| | - Elana Curtis
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand
| | - Donna Cormack
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92015, Auckland, New Zealand
| | - Louise McMillan
- Department of Statistics, Faculty of Science, University of Auckland, Private Bag 92015, Auckland, New Zealand
| | - Rob Loto
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92015, Auckland, New Zealand
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