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Kristoffersson E, Boman J, Bitar A. Impostor phenomenon and its association with resilience in medical education - a questionnaire study among Swedish medical students. BMC MEDICAL EDUCATION 2024; 24:782. [PMID: 39030556 PMCID: PMC11264822 DOI: 10.1186/s12909-024-05788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Concern over medical students' well-being is a global issue, with studies showing high psychological distress rates. Impostor Phenomenon (IP), i.e., underestimating one's abilities, attributing success to external factors, and feeling like a fraud, has been implicated as one reason behind these troubling findings. Meanwhile, resilience has been suggested to protect against psychological distress. This study aimed to investigate the prevalence of IP and its association with resilience among undergraduate medical students. METHODS The Clance Impostor Phenomenon Scale (CIPS), the Brief Resilience Scale (BRS), and sociodemographic questions were completed by 457 medical students registered in their 2-10th semester at a Swedish university. Of the respondents, 62.6% identified as women, 36.1% as men, and 1.3% as others. RESULTS The prevalence of IP was 58.4% (defined as CIPS score ≥ 62). According to the CIPS scoring guidelines, 10.3% of participants had low IP, 29.5% moderate, 41.6% frequent, and 18.6% intense IP. Of all participants, almost 90% experienced at least moderate and 60.2% frequent to intense IP. Women had significantly higher CIPS scores and lower BRS scores than men. In contrast, neither attending semester nor age group significantly impacted CIPS scores. Finally, there was a moderate inverse correlation between the level of resilience and the prevalence of IP. CONCLUSIONS Our findings suggest that the majority of Swedish medical students feels like an impostor, and of these students, most do so frequently. Furthermore, IP is more prevalent among female students - who also show lower levels of resilience. Moreover, our results indicated that IP could hinder achieving higher resilience. Future longitudinal studies should investigate how gender norms may contribute to IP feelings and explore the potential advantages of counteracting IP and strengthening resilience among medical students. However, targeted interventions addressing individual students' IP and resilience are insufficient. There is also a need to address structural aspects of the educational environment, such as gender stereotypes, that may contribute to IP.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Clinical Science, Professional Development, Umeå University, Umeå, 901 87, Sweden
| | - Jens Boman
- Department of Clinical Science, Professional Development, Umeå University, Umeå, 901 87, Sweden
| | - Aziz Bitar
- Department of Clinical Science, Professional Development, Umeå University, Umeå, 901 87, Sweden.
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Yang Z, Chen W, Chen W, Ma Q, Wang H, Jiang T, Fu Y, Zhou X. Factors associated with casual sexual behavior among college students in Zhejiang Province, China: A cross-sectional survey. PLoS One 2024; 19:e0304804. [PMID: 38995903 PMCID: PMC11244799 DOI: 10.1371/journal.pone.0304804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/17/2024] [Indexed: 07/14/2024] Open
Abstract
This study aimed to analyze the characteristics and risk factors associated with casual sexual behavior among sexually active college students and to contribute to AIDS prevention and control efforts among this demographic. A cross-sectional survey was conducted using a stratified cluster sampling technique. Self-reported sexually active college students were selected as respondents from 11 cities in Zhejiang Province from October 8 to November 30, 2018. A questionnaire was used to collect variables such as demographic information, sexual attitudes, intervention acceptance, and self-efficacy of condom use. Univariate and multivariate analyses were performed. Among 3,771 college students who reported engaging in sexual activity, 675 (17.90%) reported engaging in casual sexual encounters. The multivariate analysis revealed multiple factors associated with casual sexual behavior among students: being male, originating from a city/town, having pursued HIV testing education in the last year, seeking HIV risk self-assessment within the last year, accepting to engage in one-night stand behavior, accepting to partake in commercial sexual activity, having conducted HIV antibody tests within the last year, homosexual partner or homosexual/heterosexual partner, demonstrating self-efficacy in condom usage, and monthly living expenses falling within the range of 1001-1500 yuan. Additionally, students with knowledge that appearance does not determine HIV infection, a proclivity for seeking HIV counseling and testing following high-risk sexual behavior and awareness that the centers for disease control provides HIV diagnosis were found to have significant associations with casual sexual activity. Casual sex is significantly prevalent among college students, with male, students from urban areas, those who accepted to engage in one-night stand behavior and partook in commercial sexual activity demonstrating a higher propensity for such behavior. This tendency can be attributed to several factors including a more liberal sexual attitude, a rudimentary understanding of HIV risk, and a low adoption rate of HIV testing. Therefore, it is imperative to enhance HIV prevention and education among college students.
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Affiliation(s)
- Zhongrong Yang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang province, China
| | - Wanjun Chen
- Department of HIV/STD Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Weiyong Chen
- Department of HIV/STD Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Qiaoqin Ma
- Department of HIV/STD Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Hui Wang
- Department of HIV/STD Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Tingting Jiang
- Department of HIV/STD Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yun Fu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang province, China
| | - Xin Zhou
- Department of HIV/STD Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
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El Nouiri A, El Kassem S, Al Maaz Z, Alhajj Y, Al Moussawi A, El Yaman A, El Hajjar H, Abdallah M, Assi G, Houri M, Azakir B. Prevalence and Characteristics of Medical Student Mistreatment in Lebanon. Int J Public Health 2024; 69:1606710. [PMID: 39027015 PMCID: PMC11254615 DOI: 10.3389/ijph.2024.1606710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Objective This study aimed to determine the prevalence of medical student mistreatment in Lebanon, the framework of the incidents, and the extent of students' knowledge on mistreatment characteristics. Methods This is a cross-sectional study conducted using an online-based survey among medical students who have performed clinical rotations in Lebanon. Results Out of 300 respondents, 48.7% reported being subjected to mistreatment during clinical practice, which was significantly associated with gender, type of university, and family income. The two most common sources of mistreatment were patients and their families/friends (77.4%), and attending physicians (52.7%), followed by residents (49.3%). Students mostly chose to be passive and pacifying. Additionally, 64.7% of students stated they were not trained about the ideal way to handle these incidents. Conclusion This study showed that medical student mistreatment is highly prevalent in Lebanon. It also highlighted the lack of proper education on mistreatment characteristics and the necessity for investigating its effects.
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Affiliation(s)
- Ahmad El Nouiri
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Sarah El Kassem
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Zeina Al Maaz
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Yasser Alhajj
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - Ahmad El Yaman
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | | | - Gaith Assi
- Lebanese American University, Beirut, Lebanon
| | - Mohamad Houri
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Bilal Azakir
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
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Bod J, Buck S, Chandler I, Goldflam K, Tsyrulnik A, Coughlin R, Fujimoto J, Joseph M, Della-Giustina D, Phadke M, Boatright D. LGBTQ+ individuals are not explicitly represented in emergency medicine simulation curricula. MEDEDPUBLISH 2024; 14:30. [PMID: 38932993 PMCID: PMC11200058 DOI: 10.12688/mep.20242.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
Background Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior. Methods We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher's Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior. Results Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior. Conclusions LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.
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Affiliation(s)
- Jessica Bod
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Samuel Buck
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Iris Chandler
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Katja Goldflam
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Alina Tsyrulnik
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Ryan Coughlin
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Melissa Joseph
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Manali Phadke
- Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Dowin Boatright
- Emergency Medicine, New York University, New York, New York, USA
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Sharp S, Priddie C, Clarke AH. Examining How Black Women Medical Students Rate Their Experiences with Medical School Mistreatment on the Aamc Graduate Questionnaire. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:255-265. [PMID: 38706454 PMCID: PMC11067982 DOI: 10.5334/pme.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/13/2024] [Indexed: 05/07/2024]
Abstract
Introduction Few researchers have examined how medical student mistreatment varies by race/ethnicity and gender, specifically highlighting Black women's experiences. Moreover, researchers often fail to use theoretical frameworks when examining the experiences of minoritized populations. The purpose of this study was to examine the frequency of mistreatment US Black women medical students experience and how this compared to other students underrepresented in medicine (URiM) using intersectionality as a theoretical framework. Methods We used the Association of American Medical Colleges Graduate Questionnaire (GQ) as the data source for examining descriptive statistics and frequencies. We examined differences between US Black women (N = 2,537) and other URiM students (N = 7,863) with Mann-Whitney U tests. Results The results from this study highlighted that most Black women medical students did not experience mistreatment, yet a higher proportion of these trainees reported experiencing gendered (χ2(1) = 28.59, p < .01) and racially/ethnically (χ2(1) = 2935.15, p < .01) offensive remarks at higher frequency than their URiM counterparts. We also found US Black women medical students infrequently (27.3%) reported mistreatment from a lack of confidence for advocacy on their behalf, fear of reprisal, and seeing the incident as insignificant. Discussion A paucity of research exists on Black women medical students and even less using relevant theoretical frameworks such as intersectionality. Failure to extract Black women's experiences exacerbates alienation, invisibility, and inappropriate attention to their mistreatment.
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Affiliation(s)
- Sacha Sharp
- Department of Medicine at Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christen Priddie
- Center for Postsecondary Research, Indiana University Bloomington, Bloomington, Indiana, USA
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Blackstock OJ, Isom JE, Legha RK. Health care is the new battlefront for anti-DEI attacks. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003131. [PMID: 38656953 PMCID: PMC11042711 DOI: 10.1371/journal.pgph.0003131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Jessica E. Isom
- Vision for Equity LLC, Boston, Massachusetts, United States of America
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Rupinder K. Legha
- Antiracism in Mental Health Fellowship, Los Angeles, California, United States of America
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Betancourt RM, Baluchi D, Dortche K, Campbell KM, Rodríguez JE. Minority Tax on Medical Students: A Review of the Literature and Mitigation Recommendations. Fam Med 2024; 56:169-175. [PMID: 38467005 PMCID: PMC11136630 DOI: 10.22454/fammed.2024.268466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES Accreditation standards for MD- and DO-granting institutions require medical schools to recruit a diverse student body and educate students about diverse groups of patients. The minority tax is a summary of responsibilities assigned to racial and ethnic underrepresented faculty to achieve diversity, equity, and inclusion in medical institutions in addition to their typical academic workload. This article provides a narrative review of medical students' experiences of the minority tax and recommendations on how medical educators can support an equitable learning environment by eliminating the minority tax. METHODS We searched the PubMed, Web of Science, and Scopus databases, Google Scholar, and medical society websites, blogs, and fora for terms, including minority tax, medical students, and undergraduate medical education. We included publications if they discussed the underrepresented in medicine medical students' experiences of the minority tax. RESULTS Our search yielded six peer-reviewed original research articles and six publications of commentaries, opinion pieces, or news pieces. Students who were underrepresented in medicine reported spending more hours on diversity efforts compared with students who were not underrepresented; moreover, students reported that they had to sacrifice academic excellence in order to fulfill these additional diversity duties. CONCLUSIONS The minority tax among medical students constitutes an unequitable and unjust barrier to career advancement, and it likely represents an early cause of attrition in the pipeline of underrepresented in medicine academic faculty. Medical educators can enact specific recommendations to eliminate or mitigate the minority tax experience for medical students.
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Affiliation(s)
- Renée M. Betancourt
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of MedicinePhiladelphia, PA
| | - Donna Baluchi
- Spencer S. Eccles Health Sciences Library, University of UtahSalt Lake City, UT
| | - Kristina Dortche
- Urology Residency Training Program, Cleveland ClinicCleveland, OH
| | - Kendall M. Campbell
- Department of Family Medicine, The University of Texas Medical BranchGalveston, TX
| | - José E. Rodríguez
- Department of Family and Preventive Medicine, University of UtahSalt Lake City, UT
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Zelin NS, Scott C, Avila-Quintero VJ, Curlin K, Flores JM, Bloch MH. Sexual Orientation and Racial Bias in Relation to Medical Specialty. JOURNAL OF HOMOSEXUALITY 2024; 71:574-599. [PMID: 36269161 DOI: 10.1080/00918369.2022.2132441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.
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Affiliation(s)
| | - Carter Scott
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaveri Curlin
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Jose M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Legha R, Mabeza RM. Ethical guidelines for antiracism work in medicine: lessons from the antiracist healing collaborative. MEDICAL HUMANITIES 2024; 50:103-108. [PMID: 38388183 DOI: 10.1136/medhum-2023-012761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
An explosion of antiracism in medicine efforts have transpired since 2020. However, no ethical guidelines exist to guide them. This oversight is concerning because the racism and white supremacy rife within medicine can easily thwart them. This article addresses this gap by highlighting ethical guidelines for antiracism work in medicine. We present nine core tenets derived from our experience forming the Antiracist Healing Collaborative (AHC), a medical student-led initiative committed to developing bold and disruptive antiracist medical education content. Our lessons developing and implementing these tenets can guide other antiracism in medicine collaborations striving to promote liberation and healing, rather than recapitulating the racism and white supremacy culture embedded within medicine. We close by reflecting on how these tenets have steadied our recent decision to draw AHC to a close. They have allowed us to honour what we achieved together, strengthen the relationship that formed the foundation for our activism and bolster the shared antiracism mission that will guide our individual journeys moving forwards. The first of their kind, our ethical guidelines for antiracism work in medicine can facilitate greater recognition of the risks embedded in anti-oppression work transpiring in academic settings.
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Affiliation(s)
| | - Russyan Mark Mabeza
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
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Boatright D, Nguyen M, Hill K, Berg D, Castillo-Page L, Anderson N, Agbelese V, Venkataraman S, Saha S, Schoenbaum SC, Richards R, Jordan A, Asabor E, White MA. Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools. JAMA Netw Open 2024; 7:e240001. [PMID: 38381434 PMCID: PMC10882418 DOI: 10.1001/jamanetworkopen.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/26/2023] [Indexed: 02/22/2024] Open
Abstract
Importance Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students' perception of the climate of equity and inclusion are limited. Objective To develop and validate an instrument to measure students' perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). Design, Setting, and Participants The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education-accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. Exposures Student race and ethnicity, sex, sexual orientation, and socioeconomic status. Main Outcomes and Measures Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. Results Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students' perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). Conclusions and Relevance This study found that the new tool is a reliable and psychometrically valid measure of medical students' perceptions of equity and inclusion in the learning environment.
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Affiliation(s)
- Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | | | - David Berg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Victoria Agbelese
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Shruthi Venkataraman
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Somnath Saha
- Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Regina Richards
- Office of Diversity, Equity, Inclusion and Community Engagement, University of Colorado Anschutz Medical Campus, Aurora
| | - Ayana Jordan
- Department of Psychiatry, New York University Grossman School of Medicine
| | - Emmanuella Asabor
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Marney A. White
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Chaudron LH, Dandar V, Lautenberger D, Bunton SA, Gordon LK, Ellinas EH. Satisfaction of Women Faculty in Academic Medicine. J Womens Health (Larchmt) 2024; 33:132-140. [PMID: 38061049 DOI: 10.1089/jwh.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Purpose: Research about academic medicine women faculty has focused on comparisons of men and women or specific groups who achieved leadership. To better understand the low percentages of women in academic medicine leadership, attention should be paid to the career continuum within genders. Study findings will inform policies and programs to support women in building careers and acquiring leadership positions. Materials and Methods: Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey data are used to describe and compare women assistant, associate and full professors' perceptions of (1) career development and advancement opportunities, and (2) a culture and climate that fosters diversity, equity, and inclusion. Specific similarities and differences with men are highlighted. Results: Fifty-nine percent of women respondents were assistant, 25% associate, and 16% full professors. Associate professors of both genders were the least satisfied on the main measures. Women were less satisfied than men at each career stage across the majority of variables. Among women, fewer than half of full and associate professors, and 52% of assistant professors believe they can express their opinions without fear of retribution. While the majority at all ranks (69%-75%) report feeling respected in the workplace, among those who did not, the highest percentage of disrespect based on gender was among associate professors. Conclusions: The perceptions of >7,500 academic medicine women faculty, representing different generations and ranks, underscore the need to broadly address gender inequity and sexism throughout the career continuum. It identifies the mid-career stage as a challenging experience for both men and women. Women, especially at the associate professor rank, remain a critically dissatisfied and underresourced group that is at risk for underutilization and potentially exit from academic medicine. All ranks of women need career development and equitable policies to support their sense of belonging and career advancement.
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Affiliation(s)
- Linda H Chaudron
- Department of Medical Education, Maine Medical Center, Portland, Maine, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Valerie Dandar
- Medical School Operations Research, Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Diana Lautenberger
- Gender Equity Initiatives, Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Sarah A Bunton
- Adjunct Faculty, University Studies, Portland State University, Portland, Oregon, USA
| | - Lynn K Gordon
- Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Elizabeth H Ellinas
- Department of Anesthesiology, MCW Center for the Advancement of Women in Science and Medicine (AWSM), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Antoine C, Luc MS, Gross G, Schwitzer T, Hettal L, Conart JB, Angioi-Duprez K. [Aggressiveness and violence in daily ophthalmology practice: Descriptive analysis of a survey sent to residents and assistants in Grand Est and Bourgogne-Franche-Comté]. J Fr Ophtalmol 2024; 47:103994. [PMID: 37903682 DOI: 10.1016/j.jfo.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.
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Affiliation(s)
- C Antoine
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - M-S Luc
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - G Gross
- Centre psychothérapeutique de Nancy, 1, rue Dr-Archambault, 54520 Laxou, France
| | - T Schwitzer
- Centre psychothérapeutique de Nancy, 1, rue Dr-Archambault, 54520 Laxou, France
| | - L Hettal
- CNRS UMR 168, institut Curie, université PSL, Sorbonne Université, 26, rue d'Ulm, 75005 Paris, France
| | - J-B Conart
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - K Angioi-Duprez
- Service d'ophtalmologie, centre hospitalier universitaire de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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Danckers M, Nusynowitz J, Jamneshan L, Shalmiyev R, Diaz R, Radix AE. The sexual and gender minority (LGBTQ+) medical trainee: the journey through medical education. BMC MEDICAL EDUCATION 2024; 24:67. [PMID: 38233849 PMCID: PMC10795322 DOI: 10.1186/s12909-024-05047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
In this literature overview, we share with the reader challenges faced by LGBTQ + individuals pursuing medical education, from undergraduate to postgraduate training. The LGBTQ + acronym has evolved to encompass the diverse spectrum of sexual orientation and gender identities. Recently, the term "Sexual and Gender Minority" (SGM) has emerged as an umbrella term to provide consistency in research advancing SGM health. The unique obstacles LGBTQ + trainees encounter are highlighted throughout this article, including external factors influencing career decisions, a lack of LGBTQ + healthcare curricula, discriminatory social interactions, limited mentorship opportunities, and a higher mental health burden. These challenges have the capacity to affect educational experiences, personal well-being, and professional growth. Additionally, we examine the impact of inclusive institutional climates on LGBTQ + trainees' selection of medical schools and residency programs, as they may prioritize inclusiveness and diversity when making their choice. In postgraduate training, LGBTQ + trainees continue to face challenges, exemplified by disparities in placement rates and discriminatory experiences based on sexual orientation and gender identity. We describe the gap in current research and its long-term impact of these challenges on career paths. Hostile environments persist in certain specialties, and the lack of LGBTQ + mentorship and support can hinder academic pursuits. We shed light on the unique and pervasive challenges faced by LGBTQ + trainees throughout their medical education journey, while emphasizing the need for inclusive policies, support systems, and research to address these challenges. With increasing research and studies, we hope to create a medical workforce and community that better represents the diverse communities it serves.
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Affiliation(s)
- Mauricio Danckers
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA.
| | - Jake Nusynowitz
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Lily Jamneshan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Richard Shalmiyev
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Raiko Diaz
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Asa E Radix
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
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Geiger G, Kiel L, Horiguchi M, Martinez-Aceves C, Meza K, Christophers B, Orellana P, Pinzon MM, Lubner SJ, Florez N. Latinas in medicine: evaluating and understanding the experience of Latinas in medical education: a cross sectional survey. BMC MEDICAL EDUCATION 2024; 24:4. [PMID: 38172800 PMCID: PMC10765906 DOI: 10.1186/s12909-023-04982-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The percentage of physicians identifying as Latina has not improved despite improvements in recruitment of Latina medical students, suggesting barriers to retention and career advancement. Discriminatory experiences and mental health inflictions throughout training may contribute to difficulties in recruitment, retainment, and advancement of Hispanic/Latinx trainees, a notably understudied population. METHODS An anonymous, online survey was distributed to Latinas in the continental U.S. between June 22 to August 12, 2022. Eligibility criteria included: self-identifying as Hispanic/Latina, female/woman, and completing or have completed medical school, residency, or fellowship in the continental U.S. in the past 10 years. Recruitment was done via the Twitter account @LatinasInMed and outreach to Latino Medical Student Association chapters. Descriptive statistics summarized the self-reported experiences. RESULTS The survey included 230 Hispanic/Latinx women, mostly medical students (46.9%). A majority (54.5%) reported negative ethnicity-based interactions from patients and/or patients' families; 71.8%, from others in the medical field. High rates of depression (76.2%) and anxiety (92.6%) during training were reported by Latinas, especially medical students. Feelings of imposter syndrome and burnout were high at 90.7% and 87.4%, respectively. CONCLUSIONS This is the first study evaluating the unique experiences of Latinas in medicine, who reported discrimination and mental health struggles, specifically during medical school, at alarmingly high rates. Our findings could aid in creating the needed interventions to support Latinas in medical training to reduce the existing exodus of Latinas from medicine.
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Affiliation(s)
- Gabriella Geiger
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lauren Kiel
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Miki Horiguchi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Kelly Meza
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Briana Christophers
- Weill Cornell/Rockefeller/Memorial Sloan Kettering Tri-Institutional MD-PhD Program, New York City, NY, USA
| | | | - Maria Mora Pinzon
- Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sam J Lubner
- Division of Hematology, Medical Oncology and Palliative Care, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Lowe Center for Thoracic Oncology, Harvard Medical School, Dana-Farber Cancer Institute, 450 Brookline Ave - DA1230, 02215, Boston, MA, USA.
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Walvoord EC, Howenstine MS, Allen BL, Ribera AK, Nabhan ZM, Tori AJ, Eichholtz RD, Dankoski ME. Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment. TEACHING AND LEARNING IN MEDICINE 2024; 36:61-71. [PMID: 36106412 DOI: 10.1080/10401334.2022.2122979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners' awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.
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Affiliation(s)
- Emily C Walvoord
- Medical Student Affairs and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michelle S Howenstine
- Graduate Medical Education, Continuing Medical Education and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Bradley L Allen
- Medical Student Education and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy K Ribera
- Research and Evaluation, Faculty Affairs, Professional Development and Diversity, and Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeina M Nabhan
- Graduate Medical Education and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alvaro J Tori
- Diversity Affairs and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rebekah D Eichholtz
- Faculty Affairs, Professional Development, and Diversity, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mary E Dankoski
- Faculty Affairs, Professional Development, and Diversity and Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sorgini A, Istl AC, Downie ML, Kirpalani A. Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. MEDICAL TEACHER 2024; 46:73-81. [PMID: 37418565 DOI: 10.1080/0142159x.2023.2229503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees. METHODS We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus. RESULTS From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population. CONCLUSION This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.
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Affiliation(s)
- Alana Sorgini
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra C Istl
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London, UK
- Department of Nephrology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Nephrology, Children's Hospital, London Health Sciences Centre, London, ON, Canada
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Kirjava SA, Vallejo R. Experiences of Patient Bigotry Among Doctor of Audiology Graduate Clinicians: A Review and Recommendations. Am J Audiol 2023; 32:962-971. [PMID: 37708495 DOI: 10.1044/2023_aja-23-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
PURPOSE Students in audiology clinical doctorate programs in the United States are required to participate in direct patient care under the supervision of a licensed precepting audiologist during their schooling. Audiology student clinicians commonly rotate through a variety of clinical settings with their own organizational structure, policies, and precepting clinicians. Systemic prejudice and stigma cause many of these student clinicians to experience bigotry from the patients they work with. METHOD This review discusses the populations of audiology students at highest risk of patient bigotry and discusses the intersectionality of students with several historically marginalized identities. RESULTS Little scholarship exists in the field of audiology on the bigotry that graduate student clinicians experience. The effects of bigotry are reviewed, and practical guidance on preparing for and responding to bigotry from patients is provided. CONCLUSIONS As health care workers, these students are essential workers contributing to the health and health care of the population, making their well-being a critical public health concern. Bigotry from others has been shown to contribute to mental illness, burnout, and poorer physical health among the people experiencing it.
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Kloos J, Simon E, Sammarco A, El-Nashar S, Bazella C. Neglect as an undefined and overlooked aspect of medical student mistreatment: A systematic review of the literature. MEDICAL TEACHER 2023; 45:1395-1403. [PMID: 37300429 DOI: 10.1080/0142159x.2023.2218982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research. METHODS Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools. RESULTS Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations. CONCLUSIONS Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities.
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Affiliation(s)
- Jacqueline Kloos
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Emily Simon
- University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anne Sammarco
- Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sherif El-Nashar
- Obstetrics and Gynecology, Mayo Clinic School of Medicine and Science, Jacksonville, FL, USA
| | - Corinne Bazella
- Obstetrics and Gynecology, Case Western Reserve School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Klig JE, Stenson BA, Kivlehan SM, Jackson A, Berwick JR, Kosowsky JM. Twelve tips for practical clinical skills coaching. MEDICAL TEACHER 2023; 45:1357-1363. [PMID: 37318542 DOI: 10.1080/0142159x.2023.2220895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Coaching is rapidly evolving in clinical medicine, including for clinical skills (CS) learning. Yet a schema is needed for how to coach students in the many CS that are pivotal to the practice of medicine. These twelve tips aim to provide practical strategies for teachers and educators to coach students for CS learning. The tips cover many important aspects of CS coaching, including establishing a safe space, ways to prepare to coach, setting goals, guiding a coaching relationship, fostering coaching conversations, and in-person or virtual approaches. Together, the tips align as seven key steps of an overall coaching process. The twelve tips apply equally to coaching struggling students and all students seeking to improve CS and offer a guide for coaching at an individual or program level.
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Affiliation(s)
- Jean E Klig
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Office of Medical Education, Harvard Medical School, Boston, MA, USA
| | - Bryan A Stenson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Agnieszka Jackson
- Office of Medical Education, Harvard Medical School, Boston, MA, USA
| | - Jessica R Berwick
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua M Kosowsky
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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20
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Hill Weller L, Tang J, Chen R, Boscardin C, Ehie O. Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11360. [PMID: 38034501 PMCID: PMC10682127 DOI: 10.15766/mep_2374-8265.11360] [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: 04/02/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023]
Abstract
Introduction Graduate trainees from diverse backgrounds may experience discrimination, mistreatment, and microaggressions. While the ability to identify and respond to microaggressions is a much-needed skill for all emerging trainees, limited training workshops exist for residents, especially within perioperative medicine. To embody the principles of diversity, equity, inclusion, and anti-racism (DEIA), we aimed to empower trainees in the perioperative environment with several strategies for addressing microaggressions to bridge this training gap. Methods Based on critical race theory, transformative learning, minority stress theory, and the structural theory of gender and power, this workshop was developed with the primary aim of educating trainees on microaggressions, amplifying the role of allyship, and providing tools to respond to microaggressions as an ally. We used a mixed methods approach to examine participants' pre/post self-evaluations of microaggression intervention tools and the overall effectiveness of the workshop. Results The postsurvey captured the experiences of 54 trainees, including 37 of 44 (84%) first-year clinical anesthesia residents and 14 of 24 (58%) surgery residents. The facilitator and course feedback was remarkably positive. Paired t test analyses on participants' pre- and postsurvey responses demonstrated a statistically significant increase in knowledge of microaggressions. This workshop also significantly increased learners' self-reported tools for responding to microaggressions. Discussion Overall, these promising findings suggest that the strategies presented in this workshop could be applied across other graduate medical education programs. Institutions may wish to customize workshop elements, such as the case scenarios, and the workshop can also be incorporated within a DEIA curriculum.
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Affiliation(s)
- LaMisha Hill Weller
- Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine
| | - Janette Tang
- Fourth-Year Medical Student, University of California, San Francisco, School of Medicine
| | - Rebecca Chen
- Fourth-Year Medical Student, University of California, San Francisco, School of Medicine
| | - Christy Boscardin
- Professor, Departments of Medicine and Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine
| | - Odinakachukwu Ehie
- Associate Clinical Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine
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Nolan HA, Owen K. Twelve tips to foster healthcare student recognition and reporting of unprofessional behaviour or concerns. MEDICAL TEACHER 2023; 45:1233-1238. [PMID: 37286476 DOI: 10.1080/0142159x.2023.2218541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Medical trainees and students are required to report concerns where they identify concerning practice or behaviours. While leadership attributes and skills are increasingly expected curricular outcomes, students still struggle to report concerns due to a variety of factors. Changing societal awareness and expectations continue to shine light on poor professionalism and unethical behaviours whose reach extends to medical training and education and that need to be systematically reported and addressed. To prepare graduates for these challenges in professional practice and for exercising skills of reporting concerns, education and training environments must ensure that speaking up is ingrained in the organisational ethos. Supported by evidence from the literature and our experience of revising and enhancing approaches, this paper outlines tips for developing and embedding an infrastructure that facilitates robust concerns reporting and management. Further, we consider mechanisms that support students to develop tendencies and skills for reporting concerns.
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Connor DM, Fernandez A, Alba-Nguyen S, Collins S, Teherani A. Academic Leadership Academy Summer Program: Clerkship Transition Preparation for Underrepresented in Medicine Medical Students. TEACHING AND LEARNING IN MEDICINE 2023:1-14. [PMID: 37886897 DOI: 10.1080/10401334.2023.2269133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 09/09/2023] [Indexed: 10/28/2023]
Abstract
PROBLEM Enhancing workforce diversity by increasing the recruitment of students who have been historically excluded/underrepresented in medicine (UIM) is critical to addressing healthcare inequities. However, these efforts are inadequate when undertaken without also supporting students' success. The transition to clerkships is an important and often difficult to navigate inflection point in medical training where attention to the specific needs of UIM students is critical. INTERVENTION We describe the design, delivery, and three-year evaluation outcomes of a strengths-based program for UIM second year medical students. The program emphasizes three content areas: clinical presentations/clinical reasoning, community building, and surfacing the hidden curriculum. Students are taught and mentored by faculty, residents, and senior students from UIM backgrounds, creating a supportive space for learning. CONTEXT The program is offered to all UIM medical students; the centerpiece of the program is an intensive four-day curriculum just before the start of students' second year. Program evaluation with participant focus groups utilized an anti-deficit approach by looking to students as experts in their own learning. During focus groups mid-way through clerkships, students reflected on the program and identified which elements were most helpful to their clerkship transition as well as areas for programmatic improvement. IMPACT Students valued key clinical skills learning prior to clerkships, anticipatory guidance on the professional landscape, solidarity and learning with other UIM students and faculty, and the creation of a community of peers. Students noted increased confidence, self-efficacy and comfort when starting clerkships. LESSONS LEARNED There is power in learning in a community connected by shared identities and grounded in the strengths of UIM learners, particularly when discussing aspects of the hidden curriculum in clerkships and sharing specific challenges and strategies for success relevant to UIM learners. We learned that while students found unique benefits to preparing for clerkships in a community of UIM students, near peers, and faculty, future programs could be enhanced by pairing this formal intensive curriculum with more longitudinal opportunities for community building, mentoring, and career guidance.
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Affiliation(s)
- Denise M Connor
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Alicia Fernandez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah Alba-Nguyen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sally Collins
- Center for Faculty Educators, University of California San Francisco, San Francisco, California, USA
| | - Arianne Teherani
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Faculty Educators, University of California San Francisco, San Francisco, California, USA
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Munro-Kramer ML, Loder C, Kalpakjian C, Martin KE, Hess A, Smith E, Parrish D, Ernst S. Creating a tool to understand university students' experiences regarding inappropriate, disrespectful, and coercive (IDC) healthcare interactions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37874736 DOI: 10.1080/07448481.2023.2272190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
Objective: The purpose of this study was to develop a survey tool to capture inappropriate, disrespectful, and coercive (IDC) interactions with healthcare providers among a diverse sample of university students. Participants: Participants were university students at one large Midwestern public university. Methods: An exploratory qualitative approach was used to create a survey tool to capture IDC interactions. Results: In Phase I, 9 focus group discussions (FGDs) and 3 individual interviews were conducted with a total of 38 participants. In Phase II, 18 participants completed cognitive interviews. Themes across all FGDs included: (1) communication; (2) respect for identity; (3) institutional practices; (4) power imbalances; and (5) lack of patient education and empowerment. Queer participants discussed unique considerations of how queer identity influences one's IDC healthcare experiences. Conclusions: This study resulted in the development of a 64-70 item tool, the IDC Survey, to measure the prevalence and characteristics of IDC healthcare interactions.
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Affiliation(s)
| | - Charisse Loder
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Claire Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kiki E Martin
- Harris School of Public Policy, University of Chicago, Chicago, Illinois, USA
| | - Andrea Hess
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Smith
- Central Michigan University College of Medicine, Ann Arbor, Michigan, USA
| | | | - Susan Ernst
- University of Michigan Medical School & Chief of Gynecology at the University of Michigan University Health Service, Ann Arbor, Michigan, USA
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Lee D, Reasoner K, Davidson C, Pennings JS, Lee DH. The Relationships Between Grit, Burnout, and Demographic Characteristics in Medical Students. Psychol Rep 2023; 126:2511-2529. [PMID: 35422163 DOI: 10.1177/00332941221087899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Grit, a positive psychological trait comprised of perseverance and passion, has been correlated with physician burnout but has not been extensively studied among medical students. Identification of the relationship between grit and burnout as well as between burnout and other demographics could help to identify students at risk of burnout, while informing educational strategies to increase grit in the medical occupation. For this cross-sectional study, an online, email-based survey including demographic questions, the Maslach Burnout Inventory-Human Services (Medical Personnel) Survey, and the Short Grit Scale was distributed to an entire student body of allopathic medical students via a schoolwide listserv in 2019. The response rate was 39.6% (177/444). Negative correlations were displayed between grit and emotional exhaustion, depersonalization, and overall burnout. Positive correlation was demonstrated between grit and personal accomplishment. Male participants had higher depersonalization than female participants and fourth year medical students had higher depersonalization than other years of training. Fourth year medical students had higher personal accomplishment than other years of training and married students had higher personal accomplishment than those who had never been married. These findings are important not only for potential identification of students at risk of burnout, but also for development of strategies to bolster grit and mitigate distressing experiences in the medical occupation. Future studies are necessary to gauge how this relationship may evolve throughout a medical career.
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Affiliation(s)
- Diane Lee
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kaitlyn Reasoner
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Donald H Lee
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Vanstone M, Cavanagh A, Molinaro M, Connelly CE, Bell A, Mountjoy M, Whyte R, Grierson L. How medical learners and educators decide what counts as mistreatment: A qualitative study. MEDICAL EDUCATION 2023; 57:910-920. [PMID: 36815430 DOI: 10.1111/medu.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less-than-ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment. METHODS Using constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of 'definitely', 'maybe' and 'definitely not' maltreatment across a variety of axes including experience level, clinical setting and type of interaction. RESULTS Our data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient. CONCLUSIONS Only the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense-making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alice Cavanagh
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
- MD/PhD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Monica Molinaro
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
| | - Catherine E Connelly
- Michael G. DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Bell
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
- Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert Whyte
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
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McMahon S, Connor RA, Frye V, Cusano J, Johnson L. The presence, action, and influence of bystanders who witness sexual harassment against medical students. MEDICAL TEACHER 2023; 45:1134-1139. [PMID: 36997163 DOI: 10.1080/0142159x.2023.2193306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE Sexual harassment (SH) is a widespread problem in academia, with a disproportionate impact on female medical students and those who experience marginalization via multiple systems of oppression (e.g. racism, heterosexism). Bystander intervention education is a potential approach which frames violence as a community issue where all members have a role to play in response and prevention. This study assessed the presence and influence of bystanders in SH situations for students at two medical schools. MATERIALS AND METHODS Data came from a larger U.S. campus climate study administered online in 2019 and 2020. The sample included 584 students who responded to validated survey questions about sexual harassment experiences, bystander behavior, disclosure, perceptions of the university response to SH, and demographics. RESULTS More than one-third of respondents experienced some form of SH by a faculty/staff member. Bystanders were present for more than half of these incidents, yet they rarely intervened. When bystanders intervened, people were more likely to disclose an incident than not. CONCLUSIONS The results indicate that there are many missed opportunities for intervention and given the profound impact that SH has on the well-being of medical students, continued work is needed to determine effective intervention and prevention methods.[Box: see text].
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Affiliation(s)
- Sarah McMahon
- Center for Research on Ending Violence, School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Rachel A Connor
- Center for Research on Ending Violence, School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Victoria Frye
- School of Medicine, City University of New York, New York, NY, USA
| | - Julia Cusano
- Center for Research on Ending Violence, School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Laura Johnson
- School of Social Work, Temple University, Philadelphia, PA, USA
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Yang DH, Justen M, Lee D, Kim H, Boatright D, Desai M, Tiyyagura G. Experiences with Racism Among Asian American Medical Students. JAMA Netw Open 2023; 6:e2333067. [PMID: 37695582 PMCID: PMC10495868 DOI: 10.1001/jamanetworkopen.2023.33067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students. Objective To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment. Design, Setting, and Participants This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years. Main Outcomes and Measures The medical school experiences of Asian American medical students. Results Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future. Conclusions and Relevance In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.
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Affiliation(s)
- David H. Yang
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Marissa Justen
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Dana Lee
- Yale University School of Medicine, Hew Haven, Connecticut
| | - Heeryoung Kim
- Department of Psychiatry, Middlesex Hospital, Middletown, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University School of Medicine, New York
| | - Miraj Desai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gunjan Tiyyagura
- Department of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Holdren S, Iwai Y, Lenze NR, Weil AB, Randolph AM. A Novel Narrative Medicine Approach to DEI Training for Medical School Faculty. TEACHING AND LEARNING IN MEDICINE 2023; 35:457-466. [PMID: 35608161 DOI: 10.1080/10401334.2022.2067165] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
Problem:Diversity, Equity, and Inclusion (DEI) trainings for medical school faculty often lack self-reflective and pedagogically focused components that may promote incorporation of anti-racism and social justice into medical school curricula. Intervention: A four-session Narrative Medicine (NM) anti-racism program was designed for medical school faculty using critical race theory, phenomenology, and NM methods. Each workshop consisted of a lecture on key NM concepts and a small-group breakout session incorporating group discussion, close reading, and reflective writing. Context: This NM anti-racism program was developed and implemented in April 2021 by two medical students for faculty at an institution in the southeastern U.S. The program was supported by the Office of Inclusive Excellence at the institution and held in collaboration with the institution's medical education teaching academy. Program evaluation consisted of pre- and post-program surveys, which queried participants' previous experiences with DEI and medical humanities programs, perceptions of self-identity and privilege, and confidence in teaching concepts of anti-racism. Of the total program participants (n = 32), 19 completed both surveys (54.3%). Survey data were analyzed using bivariate testing methods and qualitative thematic analysis. Impact: Post-program surveys showed 13 (68.4%) participants felt "somewhat more" or "more" comfortable engaging in concepts of race, and 12 (63.2%) participants felt "somewhat more" or "more" comfortable including topics of race into their teaching compared to before the program. Five themes were generated following qualitative analysis: (1) the value of longitudinal narrative reflection in a small-group setting for DEI work; (2) desire to commit more time to DEI, anti-racist, and social justice work while balancing busy teaching and clinical schedules; (3) the value of storytelling in DEI and anti-racism programming; (4) an understanding of deconstructive and reconstructive work of anti-racism in medicine; and (5) an increased ability to educate and enact change through teaching, activism, and institutional cultural and policy changes. Lessons Learned: This novel NM DEI training for medical school faculty was successful in increasing comfort discussing and teaching concepts of race in the medical school classroom, while providing a uniquely reflective space for personal growth. Participation in this longitudinal reflective experience was limited by physician schedules, therefore efforts to make time to participate in similar longitudinal interventions must be undertaken.
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Affiliation(s)
- Sarah Holdren
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Yoshiko Iwai
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nicholas R Lenze
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amy B Weil
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Antonia M Randolph
- Department of American Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Anderson N, Nguyen M, Marcotte K, Ramos M, Gruppen LD, Boatright D. The Long Shadow: A Historical Perspective on Racism in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S28-S36. [PMID: 37071703 PMCID: PMC10584990 DOI: 10.1097/acm.0000000000005253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
To dismantle racism in U.S. medical education, people must understand how the history of Christian Europe, Enlightenment-era racial science, colonization, slavery, and racism shaped modern American medicine. Beginning with the coalescence of Christian European identity and empire, the authors trace European racial reasoning through the racial science of the Enlightenment into the White supremacist and anti-Black ideology behind Europe's global system of racialized colonization and enslavement. The authors then follow this racist ideology as it becomes an organizing principle of Euro-American medicine and examine how it manifests in medical education in the United States today. Within this historical context, the authors expose the histories of violence underlying contemporary terms such as implicit bias and microaggressions. Through this history, they also gain a deeper appreciation of why racism is so prevalent in medical education and how it affects admissions, assessments, faculty and trainee diversity, retention, racial climate, and the physical environment. The authors then recommend 6 historically informed steps for confronting racism in medical education: (1) incorporate the history of racism into medical education and unmask institutional histories of racism, (2) create centralized reporting mechanisms and implement systematic reviews of bias in educational and clinical activities, (3) adopt mastery-based assessment in medical education, (4) embrace holistic review and expand its possibilities in admissions, (5) increase faculty diversity by using holistic review principles in hiring and promotions, and (6) leverage accreditation to combat bias in medical education. These strategies will help academic medicine begin to acknowledge the harms propagated throughout the history of racism in medicine and start taking meaningful steps to address them. Although the authors have focused on racism in this paper, they recognize there are many forms of bias that impact medical education and intersect with racism, each with its particular history, that deserve their own telling and redress.
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Affiliation(s)
- Nientara Anderson
- N. Anderson is a resident, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mytien Nguyen
- M. Nguyen is an MD-PhD student, Yale School of Medicine, New Haven, Connecticut
| | - Kayla Marcotte
- K. Marcotte is an MD-PhD student, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marco Ramos
- M. Ramos is assistant professor, Section of History of Science and Medicine and Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Larry D Gruppen
- L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Dowin Boatright
- D. Boatright is vice chair of research, Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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Cruz-Kan K, Dufault B, Fesehaye L, Kornelsen J, Hrymak C, Zubert S, Ratana P, Leeies M. Intersectional characterization of emergency department (ED) staff experiences of racism: a survey of ED healthcare workers for the Disrupting Racism in Emergency Medicine (DRiEM) Investigators. CAN J EMERG MED 2023; 25:617-626. [PMID: 37389771 DOI: 10.1007/s43678-023-00533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The impact of racism on patient outcomes in Emergency Medicine has been examined but there have been few studies exploring the experiences of racism in health care workers. This survey aims to explore the experience of racism by interdisciplinary staff in a tertiary ED. By characterizing the staff experience of racism in the ED, we hope to inform the design of strategies to disrupt racism and ultimately improve the health and wellness of both staff and patients. METHODS We conducted a self-administered, cross-sectional survey to explore the reported experience of racism by healthcare workers in a single urban ED in an academic trauma centre. We employed classification and regression tree analyses to evaluate predictors of racism through an intersectional lens. RESULTS A majority (n = 200, 75%) of all ED staff reported experiencing interpersonal racism (including physical violence, direct verbal violence, mistreatment and/or microaggressions) in the workplace. Respondents who identified as racialized self-reported significantly more racism at work than white respondents (86% vs. 63%, p < 0.001). Occupation, race, migrant status and age were identified through intersectional machine-learning models to be significantly predictive of the experience of racism. Nearly all respondents felt that the disruption of racism in Emergency medicine is important to them (90%, n = 207) and (93%, n = 214) were willing to participate in further training in anti-racism. CONCLUSIONS Racism against interdisciplinary staff working in EDs is common and the burden on healthcare workers is high. Intersections of occupation, race, age and migrant status are uniquely predictive of the experience of racism for EM staff. Interventions to disrupt racism should be informed by intersectional considerations to create a safe working environment and target populations most at risk. ED healthcare workers are willing to take steps to disrupt racism in their workplace and need institutional support to do so.
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Affiliation(s)
- Kanisha Cruz-Kan
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lula Fesehaye
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Jodi Kornelsen
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Shelly Zubert
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, Shared Health Manitoba, Winnipeg, MB, Canada.
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Torres Acosta MA, Chandra S, Li S, Yoon E, Selgrade D, Quinn J, Ardehali H. The impact of underrepresented minority or marginalized identity status on training outcomes of MD-PhD students. BMC MEDICAL EDUCATION 2023; 23:428. [PMID: 37291579 PMCID: PMC10251672 DOI: 10.1186/s12909-023-04399-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
Dual-degree MD-PhD programs have historically lacked diversity of race, ethnicity, gender, sexual orientation, and other facets of identity. Like MD- and PhD-granting programs, MD-PhD program training environments are also marked by structural barriers that negatively impact measurable academic outcomes of underrepresented and/or marginalized students in academic medicine (racial and ethnic minority groups considered underrepresented by the National Institute of Health, sexual and gender minorities, individuals with disabilities, and individuals of low socioeconomic status). In this article, we review the existing literature on MD-PhD program disparities affecting students from these groups and provide recommendations grounded on the reviewed evidence. Our literature review identified four generalizable barriers that can impact the training outcomes of students from these marginalized and/or underrepresented groups: 1) discrimination and bias, 2) impostor syndrome and stereotype threat, 3) lack of identity-similar mentors, and 4) suboptimal institutional policies and procedures. We propose goal-oriented interventions that may begin to ameliorate the disparities present in MD-PhD program training environments that affect students from marginalized and/or underrepresented groups in academic medicine.
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Affiliation(s)
- Manuel A Torres Acosta
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA.
- Northwestern University's Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Sidhanth Chandra
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Sophia Li
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Department of Biomedical Engineering, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Esther Yoon
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Daniel Selgrade
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jeanne Quinn
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Hossein Ardehali
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA.
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Spaans I, de Kleijn R, Seeleman C, Dilaver G. 'A role model is like a mosaic': reimagining URiM students' role models in medical school. BMC MEDICAL EDUCATION 2023; 23:396. [PMID: 37264380 DOI: 10.1186/s12909-023-04394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Role modelling is a widely acknowledged element of medical education and it is associated with a range of beneficial outcomes for medical students, such as contributing to professional identity development and a sense of belonging. However, for students who are racially and ethnically underrepresented in medicine (URiM), identification with clinical role models may not be self-evident, as they have no shared ethnic background as a basis for social comparison. This study aims to learn more about the role models of URiM students during medical school and about the added value of representative role models. METHODS In this qualitative study we used a concept-guided approach to explore URiM alumni's experiences with role models during medical school. We conducted semi-structured interviews with ten URiM alumni about their perception of role models, who their own role models were during medical school and why they considered these figures as role models. Sensitizing concepts guided the topic list, interview questions and finally served as deductive codes in the first round of coding. RESULTS The participants needed time to think about what a role model is and who their own role models are. Having role models was not self-evident as they had never thought about it before, and participants appeared hesitant and uncomfortable discussing representative role models. Eventually, all participants identified not one, but multiple people as their role model. These role models served different functions: role models from outside medical school, such as parents, motivated them to work hard. Clinical role models were fewer and functioned primarily as examples of professional behaviour. The participants experienced a lack of representation rather than a lack of role models. CONCLUSIONS This study presents us with three ways to reimagine role models in medical education. First, as culturally embedded: having a role model is not as self-evident as it appears in existing role model literature, which is largely based on research conducted in the U.S. Second, as cognitive constructs: the participants engaged in selective imitation, where they did not have one archetypical clinical role model, but rather approach role models as a mosaic of elements from different people. Third, role models carry not only a behavioural but also a symbolical value, the latter of which is particularly important for URiM students because it relies heavier on social comparison.
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Affiliation(s)
- Isabella Spaans
- Educational Center, University Medical Center Utrecht, Postbus 85500 (HP: HB 4.05), Utrecht, 3508, GA, The Netherlands.
| | - Renske de Kleijn
- Educational Center, University Medical Center Utrecht, Postbus 85500 (HP: HB 4.05), Utrecht, 3508, GA, The Netherlands
| | - Conny Seeleman
- Educational Center, University Medical Center Utrecht, Postbus 85500 (HP: HB 4.05), Utrecht, 3508, GA, The Netherlands
| | - Gönül Dilaver
- Educational Center, University Medical Center Utrecht, Postbus 85500 (HP: HB 4.05), Utrecht, 3508, GA, The Netherlands
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Thomas YT, Chary AN, Suh MI, Samaei M, Dobiesz V, Kalantari A, Buehler G, Das D, Wolfe J. The development of an educational workshop to reframe and manage professional conflict via a sex and gender lens. AEM EDUCATION AND TRAINING 2023; 7:e10872. [PMID: 37261219 PMCID: PMC10227172 DOI: 10.1002/aet2.10872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/13/2022] [Accepted: 12/28/2022] [Indexed: 06/02/2023]
Abstract
Background Conflict is inevitable in the emergency department, and conflict resolution is an essential skill for emergency providers to master. Effective conflict management can optimize patient care and enhance professional satisfaction. To communicate effectively in high-stress, high-impact situations, sex- and gender-based differences need to be considered. Methods Nine resident, fellow, junior, and senior faculty members of the Academy for Women in Academic Emergency Medicine collaborated to design a 4-h workshop. The focus was on professional communication and conflict resolution in emergency medicine (EM), with special attention on how sex and gender can influence these processes. Results The final educational workshop utilized a variety of formats focused on communication and effective conflict resolution including: traditional didactics, facilitated small groups with case-based learning, expert panel discussion, and an experiential learning session. The consideration of how sex- and gender-associated factors might contribute additional complexity or challenges to conflictual interactions were interwoven into each session to highlight alternative vantage points. Conclusions Effective conflict resolution is an important skill for success in EM. We developed a workshop that went beyond typical communication-based programming to consider how sex- and gender-related factors influence communication and conflict resolution.
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Affiliation(s)
- Ynhi T. Thomas
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Anita N. Chary
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Michelle I. Suh
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Mehrnoosh Samaei
- Emory Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Valerie Dobiesz
- Department of Emergency MedicineSTRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Harvard Humanitarian InitiativeBostonMassachusettsUSA
| | - Annahieta Kalantari
- Department of Emergency MedicinePenn State Health Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Greg Buehler
- Henry J.N. Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Devjani Das
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Jeannette Wolfe
- Department of Emergency MedicineUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMassachusettsUSA
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Green CA. Resilience - The Last Thing We Need. N Engl J Med 2023; 388:e62. [PMID: 37133594 DOI: 10.1056/nejmpv2303217] [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: 05/04/2023]
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Saadi A, Taleghani S, Dillard A, Ryan G, Heilemann M, Eisenman D. Original Research: Nurses' Experiences with Racial, Ethnic, Cultural, and Religious Discrimination in the Workplace: A Qualitative Study. Am J Nurs 2023; 123:24-34. [PMID: 37021974 DOI: 10.1097/01.naj.0000931892.39368.e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND As the health care workforce diversifies, understanding and addressing the lived experiences of health care professionals facing prejudice and discrimination becomes increasingly important. Previous studies have focused on physicians and medical trainees, but there remains a dearth of research exploring nurses' experiences-even though nurses make up the largest sector of the nation's health care workforce. OBJECTIVE This qualitative study explored nurses' experiences of personally mediated workplace discrimination based on race, ethnicity, culture, or religion. METHODS We conducted in-depth interviews with a convenience sample of 15 RNs at one academic medical center. Using an inductive thematic analysis approach, we identified several themes emerging from RNs' experiences and responses to a discriminatory event ("encounter"). Themes were grouped across three phases: pre-encounter, encounter, and post-encounter. RESULTS Participants reported wide-ranging experiences, from insensitive joking to overt exclusion, coming from various people including patients, patients' family members, colleagues, and physicians. For many, discrimination was cumulative: similar encounters occurred outside the workplace as well as within the clinical setting, often repeatedly, and were influenced by the sociopolitical context. Participants reported a variety of responses, including emotional reactions such as shock, fear of retaliation, and frustration at being expected to represent one's identity group. Silence or inaction predominated bystander and supervisor responses. Although the encounters themselves were fleeting, their impact was enduring. Early-career encounters were most challenging, and participants grappled internally with lasting effects for years. Long-term effects included avoidance of perpetrators, disconnection from colleagues and their own professional role, and leaving the workplace. CONCLUSIONS The findings illuminate nurses' experiences with racial, ethnic, cultural, and religious discrimination in the workplace. Understanding how such discrimination affects nurses is critical to developing effective responses to encounters, creating safer workplaces, and promoting equity within the profession.
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Affiliation(s)
- Altaf Saadi
- Altaf Saadi is an assistant professor in the Department of Neurology at Harvard Medical School and Massachusetts General Hospital, Boston. Sophia Taleghani is a resident physician in the Department of Medicine and Pediatrics at the David Geffen School of Medicine, University of California, Los Angeles (UCLA). Attallah Dillard is a doctoral student at the UCLA School of Nursing, where MarySue Heilemann is a professor. Gery Ryan is a professor in the Department of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA. David Eisenman is a professor in the Department of Medicine, UCLA David Geffen School of Medicine, and the Department of Community Health Sciences, UCLA Fielding School of Public Health. Contact author: Altaf Saadi, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Ghanney Simons EC, Nettey OS. Working harder for less - under-represented in medicine women in academic and clinical urology. Nat Rev Urol 2023:10.1038/s41585-023-00767-6. [PMID: 37081124 DOI: 10.1038/s41585-023-00767-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Efe Chantal Ghanney Simons
- David Geffen School of Medicine (DGSOM) at the University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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Incongruous identities: Mental distress and burnout disparities in LGBTQ+ health care professional populations. Heliyon 2023; 9:e14835. [PMID: 37009240 PMCID: PMC10039783 DOI: 10.1016/j.heliyon.2023.e14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023] Open
Abstract
Health care professionals are chronically overworked due to structural workplace demands and institutional challenges [1]. During the COVID-19 pandemic, US biomedical health care professionals experienced additional environmental strain [2]. Health care professionals who occupy socio-politically minoritized identities are more likely to report symptoms of distress and workplace overburden than their counterparts [2]. While minority stress and identity formation theories explain the relationship between socially constructed identity and environmental strain, these theories remain largely unexplored in LGBTQ+ health care professional populations. Furthermore, contemporary investigations into health care professional burnout and mental distress fail to include differential impacts of identity-based stress, particularly within LGBTQ+ groups. This paper proposes a theoretical explanation for differential stress experiences by health care professionals and calls for research to investigate identity congruence as a key aspect of professionalization in medical schools. Health professions researchers need to attend to identity-based stress models to address discriminatory experiences with burnout and mental distress.
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Legha RK, Martinek NN. White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse. MEDICAL HUMANITIES 2023; 49:142-146. [PMID: 36241381 DOI: 10.1136/medhum-2022-012398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/16/2023]
Abstract
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
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Hall J, Atkinson A, Chan MK, Tourian L, Thoma B, Pattani R. The Clinical Learning Environment in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:41-45. [PMID: 36998502 PMCID: PMC10042790 DOI: 10.36834/cmej.75537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jena Hall
- University of Calgary, Alberta, Canada
| | | | | | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
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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: 0] [Impact Index Per Article: 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: 3] [Impact Index Per Article: 1.5] [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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