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Becerra-Culqui T, Swiatek D, Dizon B, Getahun D, Silverberg M, Zhang Q, Im T, Goodman M. Challenging Norms: The Impact of Transgender and Gender-Diverse Realities on Work and School Participation. Am J Occup Ther 2024; 78:7803205150. [PMID: 38536733 PMCID: PMC11117465 DOI: 10.5014/ajot.2024.050485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
IMPORTANCE Disruption in school and the workplace are health concerns for transgender people. OBJECTIVE To evaluate transgender individuals' thoughts and comfort with how others perceive their gender identity (social affirmation) and its association with outness in the workplace and mistreatment at work or school. DESIGN Cross-sectional survey. PARTICIPANTS Survey respondents older than age 18 yr from the Study of Transition, Outcomes & Gender cohort (N = 696; n = 350 assigned male at birth, n = 346 assigned female at birth [AFAB]). OUTCOMES AND MEASURES Ever "out" to employer and treated unfairly at work or school or fired from job. Predictors were high social affirmation and comfort with how others perceive own gender identity. Descriptive statistics and logistic regression were used for analyses. RESULTS Individuals reporting high social affirmation were less likely to experience mistreatment at work or school than those with low social affirmation (odds ratio [OR] = 0.57, 95% confidence interval [CI] [0.38, 0.86]). Individuals AFAB who felt comfortable with how others perceived their gender identity were less likely to be out to their employers than individuals AFAB who did not (OR = 0.45; 95% CI [0.20, 0.97]). CONCLUSIONS AND RELEVANCE Individuals with high social affirmation were less likely to experience work or school mistreatment, and feeling comfortable with how others perceive their gender identity did not signify the need to be out. Plain-Language Summary: Occupational therapy practitioners can play a pivotal role when working with transgender individuals by assisting in creating new routines for self-presentation at work or school, navigating social environments, and providing guidance in self-advocacy skills. Individuals assigned male at birth may be in greater need because they report lower levels of social affirmation and acceptance at school and work than individuals assigned female at birth.
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Affiliation(s)
- Tracy Becerra-Culqui
- Tracy Becerra-Culqui, PhD, MPH, OT/L, is Assistant Professor, Department of Occupational Therapy, California State University Dominguez Hills, Carson;
| | - Daniel Swiatek
- Daniel Swiatek, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, California State University Dominguez Hills, Carson
| | - Bernadine Dizon
- Bernadine Dizon, MPH, is Research Associate IV, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Darios Getahun
- Darios Getahun, MD, PhD, MPH, is Research Scientist II, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, and Associate Professor, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Michael Silverberg
- Michael Silverberg, PhD, MPH, is Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, and Professor, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Qi Zhang
- Qi Zhang, MSPH, is PhD Student, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Theresa Im
- Theresa Im, MPH, is Research Project Manager, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Michael Goodman
- Michael Goodman, MD, MPH, is Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Aysola J, Murdock HM, Lett E, Williams C, Wade R, Higginbotham EJ. Operationalizing inclusion: moving from an elusive goal to strategic action. Epidemiol Rev 2023; 45:140-145. [PMID: 37259471 DOI: 10.1093/epirev/mxad005] [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: 08/30/2022] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
To mitigate the structural and institutional biases that contribute to inequities in health, we need a diverse cadre of individuals to feel included and advance within our field in order to bring a multicultural set of perspectives to the studies we conduct, the science we generate, the health and academic systems we design, and the medical and scientific knowledge we impart. There has been increasing focus on diversity, inclusion, and equity in recent years; however, often these terms are presented without adequate precision and, therefore, the inability to effectively operationalize inclusion and achieve diversity within organizations. This narrative review details several key studies, with the primary objective of presenting a roadmap to guide defining, measuring, and operationalizing inclusion within work and learning environments.
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Affiliation(s)
- Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Medicine, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
- Department of Pediatrics, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
| | - H Moses Murdock
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elle Lett
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, PA 19104, United States
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, United States
| | - Corey Williams
- MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of PA, Philadelphia, PA 19104, United States
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19178, United States
| | - Eve J Higginbotham
- Office of Inclusion, Diversity, and Equity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Guevara JP, Aysola J, Wade R, Nfonoyim B, Qiu M, Reece M, Carroll KN. Diversity in the pediatric research workforce: a scoping review of the literature. Pediatr Res 2023; 94:904-914. [PMID: 37185966 PMCID: PMC10129297 DOI: 10.1038/s41390-023-02603-4] [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: 06/12/2021] [Revised: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors' personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a "leaky pipeline." Strategies to plug the "leaky pipeline" include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics. IMPACT: Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation. This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement. Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates. Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.
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Affiliation(s)
- James P Guevara
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jaya Aysola
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bianca Nfonoyim
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maylene Qiu
- Biotech Commons Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Reece
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kecia N Carroll
- Department of Pediatrics, Mt Sinai School of Medicine, New York, NY, USA
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Russel SM, Carter TM, Wright ST, Hirshfield LE. How Do Academic Medicine Pathways Differ for Underrepresented Trainees and Physicians? A Critical Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:00001888-990000000-00537. [PMID: 37556817 PMCID: PMC10834859 DOI: 10.1097/acm.0000000000005364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiM's in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine. METHOD The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted. RESULTS Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multi-pronged approaches changed every step of the recruitment and promotion processes. CONCLUSIONS These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.
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Affiliation(s)
- Sarah M Russel
- S.M. Russel is a third-year resident physician, Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-9299-8047
| | - Taylor M Carter
- T.M. Carter is a fourth-year resident physician, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, and a surgical education fellow, University of Utah, Salt Lake City, Utah
| | - Sarah T Wright
- S.T. Wright is a librarian, Health Sciences Library, University of North Carolina, Chapel Hill, North Carolina
| | - Laura E Hirshfield
- L.E. Hirshfield is The Dr. Georges Bordage Medical Education Faculty Scholar and associate professor of medical education and sociology, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0894-2994
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5
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Nakae S, Martinez S, Juarez JJ, Beltran Sanchez C. The Impacts of Engagement in the Latino Medical Student Association. Health Equity 2023; 7:109-115. [PMID: 36876234 PMCID: PMC9982135 DOI: 10.1089/heq.2022.0099] [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: 01/17/2023] [Indexed: 02/18/2023] Open
Abstract
Importance The Latino Medical Student Association (LMSA) is a student-run national organization founded in 1972 dedicated to recruiting and retaining members enrolled in health professions programs through academic and social support activities. This study investigates the career impact of member participation in LMSA. Objective To determine if engagement in LMSA at the individual and school levels contributes to retention, success, and commitment to underserved communities. Design A voluntary online retrospective 18-question survey sent to LMSA-member medical students in the United States and Puerto Rico from the graduating classes of 2016-2021. Setting Students in medical schools in the United States and Puerto Rico. Main Outcomes and Measures There were 18 survey questions. A total of 112 anonymous responses were collected from March 2021 to September 2021. The survey queried levels of engagement with the LMSA and agreement on questions related to support, belonging, and career development. Results There is a positive relationship between level of engagement in the LMSA and social belonging, peer support, career networking, community engagement, and career commitment to serve Latinx communities. These positive outcomes were enhanced for respondents reporting strong support for their respective school-based LMSA chapters. We did not find a significant relationship between participation in the LMSA and research experiences during medical school. Conclusions and Relevance Participation in the LMSA is associated with positive individual support and career outcomes for members. Supporting the LMSA as a national organization and within school-based chapters can increase support for Latinx trainees and enhance career outcomes.
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Affiliation(s)
- Sunny Nakae
- Department of Medical Education, California University of Science and Medicine, Colton, California, USA
| | - Stacey Martinez
- Swedish Cherry Hill Family Medicine Residency Program, Seattle, Washington, USA
| | - Jordan J Juarez
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Rezai M, Lindsay S, Ahmed H, Vijayakumar A. Workplace inclusion: A scoping review of the qualitative literature. Work 2022; 75:59-73. [PMID: 36591672 DOI: 10.3233/wor-211343] [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: 12/31/2022] Open
Abstract
BACKGROUND An inclusive workplace culture supports and values the individual and collective work processes of workers from diverse backgrounds. The reality or perception of inclusion or exclusion at work can influence the social functioning, health, and well-being of workers. However, we lack knowledge about the concepts relevant to inclusion at the workplace. Furthermore, research is needed to better understand the drivers and obstacles to workplace inclusion to better promote participation in working life. OBJECTIVE This scoping review of the qualitative literature identifies the barriers to and facilitators of workplace inclusion. METHODS Systematic searches of five databases were conducted from 2000 to January 2020. Pairs of reviewers independently screened and reviewed all citations and full-text articles. We used Arksey and O'Malley's scoping review framework which advances through five stages. Barriers and facilitators of workplace inclusion were categorized relative to a multi-layered conceptualization of workplace inclusion and grouped by theme. Studies were described and thematic results totaled and communicated with evidence tables and conceptual maps. RESULTS Thirty-nine qualitative studies met our inclusion criteria. All five domains of the multi-layered framework were represented by the reported shared experiences of study participants. Organizational level factors, especially attitudinal barriers were the most reported barriers to workplace inclusion. Facilitators of workplace inclusion focused on employer level factors and most often cited the role of inclusive leadership and support. CONCLUSION Workplace inclusion requires consideration of societal, organizational, employer, and interpersonal level factors in addition to individual worker characteristics.
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Affiliation(s)
- Mana Rezai
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Hiba Ahmed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Abirami Vijayakumar
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Yemane L, Ramirez M, Guerin A, Floyd B, Okorie CU, Ling W, Addala A, Figg L, Talley EM, Chamberlain L. Sparking a Movement, Not a Moment: Framework and Outcomes From a Pediatrics Department-Wide Coalition to Advance Anti-Racism. Acad Pediatr 2022:S1876-2859(22)00527-7. [PMID: 36216211 DOI: 10.1016/j.acap.2022.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Stanford Pediatrics Advancing Anti-Racism Coalition (SPAARC) was created to promote a culture of anti-racism through immediate action, development of nimble systems, and longitudinal commitment toward equity. Evaluate gaps in the Stanford Department of Pediatrics (DoP) efforts to advance anti-racism and form a coalition of faculty, staff, and trainees to prioritize, design, and implement targeted activities with immediate and long-term measurable outcomes. METHODS A needs assessment was conducted across all DoP members in July to August 2020 to identify gaps in anti-racism efforts. Listening sessions were recorded and transcribed to extrapolate key themes and 2 rounds of consensus surveys were done to identify and prioritize actions. Actions teams were created and co-led by faculty-staff dyads with trainee representation. A final activity survey was conducted in January 2021 to determine the specific activities (ie, interventions) each team would design and implement. RESULTS Ten small group listening sessions (70 participants) and 3 surveys (1005 responses) led to the creation of 7 action teams with associated activities 1) training, 2) community engagement and research, 3) communication, 4) faculty and staff recruitment and advancement, 5) leadership representation, 6) human resources, and 7) staff engagement. Four hundred forty-three (41%) DoP members were directly involved in SPAARC through participation in the needs assessment, action teams, and/or implementation of activities. CONCLUSION SPAARC can serve as an adaptable framework for how a DoP can create a coalition to identify gaps in anti-racism efforts and create and implement targeted activities with associated outcomes.
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Affiliation(s)
- Lahia Yemane
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine (L Yemane, B Floyd, and L Chamberlian), Palo Alto, Calif.
| | - Melanie Ramirez
- David Geffen School of Medicine at UCLA (M Ramirez), Los Angeles, Calif
| | - Allison Guerin
- Department of Pediatrics, Office of Pediatric Education, Stanford University School of Medicine (A Guerin), Palo Alto, Calif
| | - Baraka Floyd
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine (L Yemane, B Floyd, and L Chamberlian), Palo Alto, Calif
| | - Caroline Ua Okorie
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine (CUA Okorie), Palo Alto, Calif
| | - Weichen Ling
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine (W Ling), Palo Alto, Calif
| | - Ananta Addala
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine (A Addala and L Figg), Palo Alto, Calif
| | - Lauren Figg
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine (A Addala and L Figg), Palo Alto, Calif
| | - Elizabeth M Talley
- Division of Pediatric Nephrology, Department of Pediatrics, Stanford University School of Medicine (EM Talley), Palo Alto, Calif
| | - Lisa Chamberlain
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine (L Yemane, B Floyd, and L Chamberlian), Palo Alto, Calif
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Barbanti PCM, de Oliveira SRL, de Medeiros AE, Bitencourt MR, Victorino SVZ, Bitencourt MR, Alarcão ACJ, Egger PA, Pelloso FC, Borghesan DHP, de Souza MP, Marques VD, Pelloso SM, Carvalho MDDB. Prevalence and Impact of Academic Violence in Medical Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11519. [PMID: 36141787 PMCID: PMC9517415 DOI: 10.3390/ijerph191811519] [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: 08/09/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Situations of mistreatment in the academic environment are prevalent worldwide, but research in this area is scarce in middle-low-income countries. This study aimed to estimate the prevalence of mistreatment inflicted against Brazilian medical students. In addition, characterize these situations and analyze their consequences. Cross-sectional study conducted with 831 medical students from public and private institutions. Absolute and relative frequencies of the analyzed variables and possible associations were determined through univariate and multivariate logistic regression. Chi-square test of association with second-order Rao-Scott adjustment was also used. The response rate was 56%. Public institution pointed to a higher prevalence of mistreatment when compared to private (59% versus 43%). Female students were the most affected. Verbal and psychological aggression was more prevalent. The aggressor usually was a faculty member. Mistreatment incidence increased over the years of training, with higher rates in the internship. About 94% of the students felt affected in anyway, with 77% feeling diminished and depressed. More than 50% reported impaired academic performance. Almost 30% sought help from experts. The reporting rate was extremely low. Adequate identification of the situations by the victims, safe reporting mechanisms and, an educational system capable of maintaining an appropriate learning environment are essential to break this destructive cycle.
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Zheng YX, Jiao JR, Hao WN. Stress levels of nursing students: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30547. [PMID: 36086725 PMCID: PMC10980379 DOI: 10.1097/md.0000000000030547] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
CONTEXT Nursing students experience psychosocial stress in their workplace. Available statistics are at variance, and hence, the need to know the overall prevalence of psychosocial stress among nursing students. AIMS This study aimed to determine the prevalence of psychosocial stress among nursing students through meta-analysis. MATERIALS AND METHODS PubMed, Cochrane, Web of Science, CNKI, and China Biomedical Literature Service System were searched for articles. Search terms include "psychosocial stress," "nursing students." Articles were included if they used validated psychosocial stress assessment instruments. Of the 15 articles with data on stress prevalence, 8 met all inclusion criteria. Each article was independently reviewed by the authors and relevant data were abstracted. Statistical analysis was done using Revman 4.1. RESULTS Overall, the average score for stress among nursing students was 3.70 (95% confidence interval [CI]: [3.33, 4.06]) based on the analyzed 15 articles with a sample size of 9202. CONCLUSION This study showed that the stress level of intern nursing students was mainly moderate.
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Affiliation(s)
- Yan-xue Zheng
- Affiliated Hospital of Inner Mongolia Medical University Hohhot, Inner Mongolia, China
| | - Jia-Ru Jiao
- Affiliated Hospital of Inner Mongolia Medical University Hohhot, Inner Mongolia, China
| | - Wen-Nv Hao
- Inner Mongolia Medical University, Hohhot, China
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Lindsay S, Fuentes K, Ragunathan S, Lamaj L, Dyson J. Ableism within health care professions: a systematic review of the experiences and impact of discrimination against health care providers with disabilities. Disabil Rehabil 2022:1-17. [PMID: 35940208 DOI: 10.1080/09638288.2022.2107086] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE People with disabilities experience concerning rates of ableism and are significantly under-represented within healthcare education and professions. Focusing on healthcare professions is important for enhancing the diversity and inclusion of equity-deserving groups within the workforce. The objective of this review was to explore the experiences and impact of workplace discrimination and ableism among healthcare providers and trainees with disabilities. METHODS Systematic searches of seven databases from 2000 to January 2022 were conducted. Five reviewers independently applied the inclusion criteria, extracted the data and rated the study quality. RESULTS 48 studies met our inclusion criteria, representing 13,815 participants across six countries over a 21-year period. The findings highlighted rates and types of workplace ableism, which occurred at the institutional (i.e., inaccessible environments, physical barriers and unsupportive work environments) and individual level (i.e., negative attitudes, bullying, harassment). The impact of ableism on healthcare providers included difficulty disclosing due to fear of stigma, and effects on well-being and career development. CONCLUSIONS Our findings revealed a critical need for more research on the experiences of ableism amongst healthcare providers and the impact it has on their well-being. Further efforts should explore mechanisms for including and welcoming people with disabilities in healthcare professions.Implications for rehabilitationWorkplace ableism is prevalent in health care professions and could be discouraging people with disabilities from entering or completing health care education and training, leading to an under-representation of this equity-deserving group within health care.More efforts are needed to recruit, retain and support people with disabilities in the health care workforce.Health care providers who have a disability often experience workplace discrimination and inaccessible physical environments which can impact their health and well-being.Managers, senior leadership and health care organizations should advocate for improved social inclusion of employees with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Luiza Lamaj
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Biomedical Sciences, Ryerson University, Toronto, Canada
| | - Jaclyn Dyson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Health Sciences Department, Queens University, Kingston, Canada
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Esparza CJ, Simon M, Bath E, Ko M. Doing the Work-or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers. Front Public Health 2022; 10:900283. [PMID: 35812485 PMCID: PMC9256912 DOI: 10.3389/fpubh.2022.900283] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/26/2022] [Indexed: 12/26/2022] Open
Abstract
While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.
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Affiliation(s)
- Caitlin Jade Esparza
- School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Mark Simon
- Storywalkers Consulting, Davis, CA, United States
| | - Eraka Bath
- The Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle Ko
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
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Establishing a benchmark of diversity, equity, inclusion and workforce engagement in radiation oncology in Europe – an ESTRO collaborative project. Radiother Oncol 2022; 171:198-204. [DOI: 10.1016/j.radonc.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022]
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Kearney MD, Barg FK, Alexis D, Higginbotham E, Aysola J. Employee Health and Wellness Outcomes Associated With Perceived Discrimination in Academic Medicine: A Qualitative Analysis. JAMA Netw Open 2022; 5:e2145243. [PMID: 35089355 PMCID: PMC8800072 DOI: 10.1001/jamanetworkopen.2021.45243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Organizational culture and workplace interactions may enhance or adversely impact the wellness of all members of learning and work environments, yet a nuanced understanding of how such experiences within health care organizations impact the health and wellness of their membership is lacking. OBJECTIVE To identify and characterize the reported health and wellness outcomes associated with perceived discrimination among academic medicine faculty, staff, and students. DESIGN, SETTING, AND PARTICIPANTS This qualitative study analyzed anonymously submitted written narratives from 2016 that described experiences related to inclusion in the workplace or lack thereof. Narratives that described health outcomes associated with work- or school-based discrimination were purposively sampled. Participants were faculty, staff, and students at health-related schools or hospitals affiliated with the University of Pennsylvania. Data analysis was performed from March 2019 to January 2020. EXPOSURES Self-reported experiences, both witnessed and personal, of discrimination in the workplace. RESULTS A total of 315 narratives were collected, and 115 narratives from 115 participants were analyzed. Most respondents identified as female (70 respondents [60.9%]), non-Hispanic White (68 respondents [59.1%]), and heterosexual (89 respondents [77.4%]) and had worked at the institution for at least 1 year (99 respondents [86.0%]). The outcomes associated with adverse workplace experiences were broad and ranged in nature from emotional to mental and physical. Most reported outcomes were emotional (101 respondents [87.8%]), and more than 1 in 10 narratives (14 respondents [12.2%]) described a mental or physical health outcome. Many of the participants felt devaluated, overexerted, and hopeless, resulting in clinically relevant manifestations, such as increased stress and anxiety levels and even elevated blood pressure. CONCLUSIONS AND RELEVANCE This qualitative study identified a continuum of negative outcomes on employee health and well-being associated with perceived discrimination and chronic exclusion in the workplace. These findings suggest the need for organizations to promote inclusion as a component of workplace wellness interventions.
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Affiliation(s)
- Matthew D. Kearney
- Department of Family Medicine and Community Health and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Equity Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Frances K. Barg
- Department of Family Medicine and Community Health and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dominique Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eve Higginbotham
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jaya Aysola
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Advancement, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Davenport D, Alvarez A, Natesan S, Caldwell M, Gallegos M, Landry A, Parsons M, Gottlieb M. Faculty Recruitment, Retention, and Representation in Leadership: An Evidence-Based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine. West J Emerg Med 2022; 23:62-71. [PMID: 35060865 PMCID: PMC8782137 DOI: 10.5811/westjem.2021.8.53754] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
Improving the recruitment, retention, and leadership advancement of faculty who are under-represented in medicine is a priority at many academic institutions to ensure excellence in patient care, research, and health equity. Here we provide a critical review of the literature and offer evidence-based guidelines for faculty recruitment, retention, and representation in leadership. Recommendations for recruitment include targeted recruitment to expand the candidate pool with diverse candidates, holistic review of applications, and incentivizing stakeholders for success with diversity efforts. Retention efforts should establish a culture of inclusivity, promote faculty development, and evaluate for biases in the promotion and tenure process. We believe this guide will be valuable for all leaders and faculty members seeking to advance diversity, equity, and inclusion in their institutions.
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Affiliation(s)
- Dayle Davenport
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| | - Al’ai Alvarez
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Sreeja Natesan
- Duke University School of Medicine, Division of Emergency Medicine, Durham, North Carolina
| | - Martina Caldwell
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
| | - Moises Gallegos
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Adaira Landry
- Harvard University School of Medicine, Division of Emergency Medicine, Boston, Massachusetts
| | - Melissa Parsons
- University of Florida School of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Harris TB, Nanda A, Sargsyan LA, Chen WJA, Christner JG. The emergence of a texas collaboration to improve well-being in learning health systems. MEDICAL EDUCATION ONLINE 2021; 26:1960140. [PMID: 34353246 PMCID: PMC8354014 DOI: 10.1080/10872981.2021.1960140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
Prior models of well-being have focused on resolving issues at different levels within a single institution. Changes over time in medicine have resulted in massive turnover and reduced clinical hours that portray a deficit-oriented system. As developments to improve purpose and professional satisfaction emerge, the Texas Medical Association Committee on Physician Health and Wellness (PHW) is committed to providing the vehicle for a statewide collaboration and illuminating the path forward.To describe the existing health and wellness resources in Texas academic medical centers and understand the gaps in resources and strategies for addressing the health and wellness needs in the medical workforce, and in student and trainee populations.Various methods were utilized to gather information regarding health and wellness resources at Texas academic medical centers. A survey was administered to guide a Think Tank discussion during a PHW Exchange, and to assess resources at Texas academic medical centers. Institutional representatives from all Texas learning health systems were eligible to participate in a poster session to share promising practices regarding health and wellness resources, tools, and strategies.Survey responses indicated a need for enhancing wellness program components such as scheduled activities promoting health and wellness, peer support networks, and health and wellness facilities in academic medical centers. Answers collected during the Think Tank discussion identified steps needed to cultivate a culture of wellness and strategies to improve and encourage wellness.The Texas Medical Association Committee on Physician Health and Wellness and PHW Exchange provided a forum to share best practices and identify gaps therein, and has served as a nidus for the formation of a statewide collaboration for which institutional leaders of academic medical centers have affirmed the need to achieve the best result.
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Affiliation(s)
- Toi B. Harris
- Institutional Diversity, Inclusion and Equity & Student and Trainee Services, and Professor of Psychiatry, Pediatrics, and Family and Community Medicine, Baylor College of Medicine, Houston, Texas, and Chair, TMA Committee on Physician Health and Wellness Ad Hoc Committee on Physician and Trainee Health and Wellness, Houston, Texas, USA
| | - Anil Nanda
- A Practicing Physician in Allergy and Immunology at Asthma and Allergy Center in Lewisville and Flower Mound, Texas, Is A Clinical Associate Professor of Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, and a Member of the TMA Committee on Physician Health and Wellness Ad Hoc Committee on Education, Lewisville, Texas, USA
| | - Lilit A. Sargsyan
- Assistant Professor in the Division of Pulmonary, Critical Care, and Sleep Medicine at McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Wei-Jung A. Chen
- Department of Neuroscience and Experimental Therapeutics, Texas A&M College of Medicine, Bryan, Texas, USA
| | - Jennifer G. Christner
- School of Medicine and Associate Professor of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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16
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Guevara JP, Wade R, Aysola J. Racial and Ethnic Diversity at Medical Schools - Why Aren't We There Yet? N Engl J Med 2021; 385:1732-1734. [PMID: 34714612 DOI: 10.1056/nejmp2105578] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- James P Guevara
- From the Departments of Pediatrics (J.P.G., R.W., J.A.) and Medicine (J.A.), Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia (J.P.G., R.W., J.A.) - both in Philadelphia
| | - Roy Wade
- From the Departments of Pediatrics (J.P.G., R.W., J.A.) and Medicine (J.A.), Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia (J.P.G., R.W., J.A.) - both in Philadelphia
| | - Jaya Aysola
- From the Departments of Pediatrics (J.P.G., R.W., J.A.) and Medicine (J.A.), Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia (J.P.G., R.W., J.A.) - both in Philadelphia
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Solomon SR, Atalay AJ, Osman NY. Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1513-1517. [PMID: 34292192 DOI: 10.1097/acm.0000000000004251] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners' experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework's 4 steps-see, name, understand, and act-to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.
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Affiliation(s)
- Sonja R Solomon
- S.R. Solomon is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alev J Atalay
- A.J. Atalay is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora Y Osman
- N.Y. Osman is assistant professor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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18
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Umotong E. Consideration of equality, diversity, and inclusivity as a higher function. Br J Oral Maxillofac Surg 2021; 59:1040-1042. [PMID: 34503856 DOI: 10.1016/j.bjoms.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Equality, inclusivity, and diversity remain pertinent topics in healthcare not only for the benefit of patients but also for the workforce. Schemes have existed for many years, but in spite of the progress being made, it remains necessary to reiterate the importance of these terms and to make a conscious effort to enforce them. This paper describes prejudices and stereotypes as a function of the Bayesian brain, beyond human control, and suggests that a higher function is needed to recognise and over-ride these innate thought processes.
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Affiliation(s)
- E Umotong
- Flat 2A Avenham Tower, 16 Bank Parade, Preston, PR1 3TA.
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19
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Abstract
A truly inclusive organization cultivates a sense of belonging and value in its members, realizing their contributions are vital to its success. Acknowledging and then dismantling exclusionary systems and policies are essential to creating environments grounded in diversity and equity. This process requires intentionality, accountability, and swift action on the part of leadership. Additionally, the role of organizational accountability, through tracking performance metrics, gauging employee satisfaction and engagement, and routinely assessing identified goals and objectives, is critical to sustaining inclusivity. In this article, we present a review of the literature and offers recommendations to build and sustain an inclusive environment.
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Affiliation(s)
| | | | - Vidhya Prakash
- School of Medicine, Southern Illinois University, Springfield, Illinois
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20
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Henning MA, Stonyer J, Chen Y, Hove BAT, Moir F, Webster CS. Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2021; 31:1487-1499. [PMID: 34457988 PMCID: PMC8368306 DOI: 10.1007/s40670-021-01301-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Medical students' experiences of harassment and its influence on quality of life were examined. DESIGN A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified. RESULTS The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life. CONCLUSIONS Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.
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Affiliation(s)
- Marcus A. Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
| | - Josephine Stonyer
- School of Medicine, University of Auckland, Grafton, Auckland, 1023 New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
| | | | - Fiona Moir
- Department of General Practice and Primary Healthcare, Population Health, University of Auckland, Grafton, Auckland, 1023 New Zealand
| | - Craig S. Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
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21
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Henning MA, Stonyer J, Chen Y, Hove BAT, Moir F, Webster CS. Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2021. [PMID: 34457988 DOI: 10.1007/s40670-021-01301-2.pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Medical students' experiences of harassment and its influence on quality of life were examined. DESIGN A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified. RESULTS The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life. CONCLUSIONS Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.
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Affiliation(s)
- Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
| | - Josephine Stonyer
- School of Medicine, University of Auckland, Grafton, Auckland, 1023 New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
| | | | - Fiona Moir
- Department of General Practice and Primary Healthcare, Population Health, University of Auckland, Grafton, Auckland, 1023 New Zealand
| | - Craig S Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Building 507, Grafton, Auckland, 1023 New Zealand
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22
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Begasse de Dhaem O, Kiarashi J, Armand CE, Charleston L, Szperka CL, Lee YS, Rajapakse T, Seng EK, VanderPluym JH, Starling AJ. Ten Eleven things to facilitate participation of underrepresented groups in headache medicine research. Headache 2021; 61:951-960. [PMID: 34125956 PMCID: PMC10091268 DOI: 10.1111/head.14124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Jessica Kiarashi
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Cynthia E Armand
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA
| | - Larry Charleston
- Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Christina L Szperka
- Department of Neurology, Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yeonsoo S Lee
- Department of Medicine, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Thilinie Rajapakse
- Department of Neurology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth K Seng
- Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Psychology, Albert Einstein College of Medicine, Bronx, NY, USA
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23
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Duerme R, Dorsinville A, McIntosh-Beckles N, Wright-Woolcock S. Rationale for the Design and Implementation of Interventions Addressing Institutional Racism at a Local Public Health Department. Ethn Dis 2021; 31:365-374. [PMID: 34045838 DOI: 10.18865/ed.31.s1.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose The Bureau of Communicable Disease (BCD) at the New York City Department of Health and Mental Hygiene developed and implemented a multi-level intervention to: 1) establish bureau-wide race consciousness; 2) provide opportunities to examine the contemporary manifestations of racism impacting institutions and communities; 3) develop praxis applying a racial equity and social justice lens to communicable disease surveillance; and 4) center the experiences of Black, Indigenous, People of Color (BIPOC) staff. Methods A staff committee designed and implemented a multipronged initiative grounded in Public Health Critical Race (PHCR) praxis. The findings from a qualitative report focused on the experiences of POC staff formed the basis of the initiative. Results Three major themes were identified in the report (Microaggressions Report) as factors that resulted in institutional inequities within the workplace: race-based biases in promotion of staff; lack of opportunity sharing for professional growth; and dominant power relations silencing the voices of POC staff. Based on findings from the Microaggressions Report, BCD designed and implemented seven interventions including: 1) Racial Identity Caucusing; 2) Multimedia Learning; 3) All-staff Workshops; 4) Social Breakout Committee; 5) Surveillance and Data Equity; 6) Core Values Development; and 7) Committee for Hiring, Retention and Promotion. Conclusion We describe the rationale, design, and implementation of a multipronged intervention at a local health department as a strategy to address institutional racism. The creation of a Microaggressions Report and the PHCR methodology framed our ongoing effort to improve workplace culture and promote equitable opportunities for POC staff.
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Affiliation(s)
- Ryan Duerme
- New York City Department of Health and Mental Hygiene, Division of Disease Control, Long Island City, NY
| | - Alan Dorsinville
- New York City Department of Health and Mental Hygiene, Division of Disease Control, Long Island City, NY
| | - Natasha McIntosh-Beckles
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Long Island City, NY
| | - Stacey Wright-Woolcock
- New York City Department of Health and Mental Hygiene, Bureau of Communicable Disease, Long Island City, NY
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Ahn DJ, Garg N, Naik AG, Fan J, Wei H, Song BB, Chung K, Vela MB, Kim KE. Where Do I Fit In? A Perspective on Challenges Faced by Asian American Medical Students. Health Equity 2021; 5:324-328. [PMID: 34036216 PMCID: PMC8140354 DOI: 10.1089/heq.2020.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
Asian American medical students (AAMSs) face significant bias in the medical learning environment and are more likely than White students to perceive their school climate negatively. Little is known about the factors that contribute to AAMSs' negative experiences. This perspective aims to describe AAMSs' experiences with diversity and inclusion efforts using survey data from a midwest regional conference, Asians in Medicine: A Conference on Advocacy and Allyship. AAMS respondents reported feeling excluded from diversity and inclusion efforts and conference participants advocated for institutional culture and climate assessments stratified by race and disaggregated into Asian subgroups.
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Affiliation(s)
- Daniel J Ahn
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Namrata Garg
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Aaditi G Naik
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - James Fan
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Helen Wei
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Bonnie B Song
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kevin Chung
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Monica B Vela
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Karen E Kim
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Testing Two Student Nurse Stress Instruments in Chinese Nursing Students: A Comparative Study Using Exploratory Factor Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2020:6987198. [PMID: 33083478 PMCID: PMC7563080 DOI: 10.1155/2020/6987198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/24/2020] [Indexed: 12/16/2022]
Abstract
Background The development and transformation of nursing within professional tertiary education have exerted a great pressure and challenge upon nursing students. Stress experienced by nursing students is a common precursor of psychological distress and attrition. However, no scale is specifically used to evaluate the sources of stress experienced by nursing students in Mainland China. Aims and Objective. This study is aimed at testing and comparing the reliability and validity including sensitivity and specificity of two nursing students' stress instruments, the Chinese version of Student Nurse Stress Index Scale (SNSI-CHI), and the Stressors in Student Nursing Scale (SINS-CN) in Chinese nursing students, and describing the stress status of nursing students in China. Methods A cross-sectional survey was conducted in two nursing schools in Henan Province from August 2017 to January 2018. Data were collected by using a questionnaire comprising the Chinese version of SNSI (SNSI-CHI), the Chinese version of SINS (SINS-CN), and the Chinese Perceived Stress Scale (CPSS). Homogeneity and stability, content, construct and concurrent validity, and sensitivity and specificity were assessed. Results The Cronbach's alpha (α) of SNSI-CHI was 0.90, and the item-to-total correlations ranged from 0.35 to 0.66. The Cronbach's α of SINS-CN was 0.93, and the item-to-total correlations ranged from 0.19 to 0.61. The findings of exploratory factor analysis (EFA) confirmed a good construct validity of SNSI-CHI and SINS-CN. The Pearson's rank correlation coefficients, between total scores of SNSI-CHI and CPSS and SINS-CN and CPSS, were assessed to 0.38 (P < 0.01) and 0.39 (P < 0.01), respectively. Regarding the CPSS, as the criterion, the cut-points of SNSI-CHI and SINS-CN for the area under the receiver operator characteristic (ROC) curve were 0.77and 0.66, respectively. Conclusion Both scales are valid and reliable for evaluating the source of stress of student nurses in China. Each has its own characteristics, but the SNSI-CHI demonstrated marginal advantage over the SINS-CN. The SNSI-CHI is short, is easily understood, and with clear dimension for the nursing students, and the SNSI-CHI is more acceptable for the users in China.
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26
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Who is hurting? A prospective study of surgeon ergonomics. Surg Endosc 2021; 36:292-299. [PMID: 33523280 DOI: 10.1007/s00464-020-08274-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a paucity of prospective data related to surgeon ergonomics, which affects career longevity. Robotic surgical systems may mitigate pain and workload. We hypothesized that ergonomic outcomes would vary based on surgeon height and gender, and the relative benefit of robotic surgery would vary based on these demographics. METHODS Surgeons received questionnaires to fill out immediately before and after surgery to enable calculation of pain scores and task load. Surgeons who were ≤ 66 inches tall were considered "short". Univariable and multivariable regression analyses were performed where appropriate using Stata-MP version 14.2 (StataCorp LLC, College Station, TX). RESULTS There were 124 questionnaires given to 20 surgeons; 97 (78%) were returned, and 12 (12%) laparoscopic operations were excluded, leaving 85 (69%) questionnaires for further analysis: 33 (38%) from short surgeons, and 24 (28%) from women, for 30 (35%) robotic and 55 (65%) open operations. There were 44/85 (52%) surgeons who reported worse pain after surgery. Overall pain scores (1.1 ± 2.6 vs 1.5 ± 2.6, p = 0.70) were similar for robotic and open operations. In multivariable analysis, greater surgeon pain scores were significantly associated with short surgeons (p < 0.001), male surgeons (p < 0.001), and long operative times (p = 0.03). Physical demand was lower for robot vs open operations (median 10 vs 13, p = 0.03). When short surgeons (p = 0.04) and male surgeons (p = 0.03) were examined as sub-groups, lower physical demand during robotic operations persisted, but was lost when only examining tall surgeons (p = 0.07) and female surgeons (p = 0.13). CONCLUSIONS Short surgeons and male surgeons reported significantly more pain after both open and robotic operations but had less physical demand when using the robotic system. Future work should focus on mitigation of surgeon height-related factors and seek to understand ergonomic gender differences beyond height.
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Alexis DA, Kearney MD, Williams JC, Xu C, Higginbotham EJ, Aysola J. Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System. JAMA Netw Open 2020; 3:e2021452. [PMID: 33226428 PMCID: PMC7684446 DOI: 10.1001/jamanetworkopen.2020.21452] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/06/2020] [Indexed: 11/14/2022] Open
Abstract
Importance With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care. Objective To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments. Design, Setting, and Participants A qualitative mixed-methods analysis of survey data collected from February to April 2015, was conducted followed by analysis of narrative data collected in June 2017. The setting was 2 health systems and 4 health professional and graduate schools. Participants were faculty, trainees, staff, and students (3506 survey respondents and 52 narratives) affiliated with the University of Pennsylvania and the University of Pennsylvania Health System. Data analysis was conducted in 2018 and 2019. Exposures Independent variables included the following respondent characteristics: gender identity, sexual orientation, race/ethnicity, position, generational age group, length of employment at institution, disability status, belief system or religion, and primary site of work or study. Main Outcomes and Measures Survey questions were used to assess participants' perception and experiences of professionalism in the workplace as measured by a 5-point Likert-type scale. Results For the survey, there were 3506 respondents from a pool of 18 550 potential respondents (18.9% response rate). Of 3506 survey respondents, 2082 of 3231 (64.4%) were women, 331 of 3164 (10.5%) identified as gender or sexual minority groups, and 360 of 3178 (11.3%) were non-Hispanic Black individuals. In adjusted analyses, women compared with men (adjusted odds ratio [aOR], 1.8; 95% CI, 1.4-2.3) and Asian individuals (aOR, 2.0; 95% CI, 1.7-2.3) and Hispanic individuals (aOR, 2.0; 95% CI, 1.4-2.7) compared with non-Hispanic White individuals were more likely to value institutional professionalism. In addition, gender identity and sexual minority groups compared with heterosexual respondents (aOR, 1.5; 95% CI, 1.2-1.8) and non-Hispanic Black individuals compared with non-Hispanic White individuals (aOR, 1.3; 95% CI, 1.2-1.4) were statistically significantly more likely to consider changing jobs because of unprofessional behavior at work. The qualitative analysis of narratives revealed that marginalized populations (including but not limited to women, gender and sexual minority groups, racial/ethnic minority groups, those who identify as having a disability, and religious minority groups) reported (1) greater infringements on their professional boundaries, as well as increased scrutiny over their professional actions, and (2) a tension between inclusion vs assimilation. Conclusions and Relevance The findings of this study highlight the need for health care organizations to revisit how they define and operationalize professionalism to improve inclusivity.
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Affiliation(s)
- Dominique A. Alexis
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew D. Kearney
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - J. Corey Williams
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chang Xu
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eve J. Higginbotham
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Jaya Aysola
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia
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In reply: Comment on women anesthesiologists' journeys to academic leadership. Can J Anaesth 2020; 67:1885-1886. [PMID: 32901350 DOI: 10.1007/s12630-020-01803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022] Open
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Ehrhardt T, Shepherd A, Kinslow K, McKenney M, Elkbuli A. Diversity and inclusion among U.S. emergency medicine residency programs and practicing physicians: Towards equity in workforce. Am J Emerg Med 2020; 46:690-692. [PMID: 32863121 DOI: 10.1016/j.ajem.2020.08.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tori Ehrhardt
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Aaron Shepherd
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Kyle Kinslow
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
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Siller DH, Beck-Rabanser C, Hochleitner PDM, Exenberger DS. "Not a Woman-Question, But a Power-Question": A Qualitative Study of Third Parties on Psychological Violence in Academic Medicine. Workplace Health Saf 2020; 69:41-49. [PMID: 32812842 PMCID: PMC7739110 DOI: 10.1177/2165079920938001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Psychological violence is a persistent issue in academic medicine and affects the health and safety of health care workers. This violence is also debated as part of medical culture. Third parties, persons learning about violations after it happened, may provide an understanding of the interplay between gender and psychological violence. Perspectives on research on psychological violence in academic medicine are currently lacking. Methods In this qualitative exploratory study, interviews were conducted with women from a working group on equal treatment at one medical university in Austria. This group monitors discrimination and harassment and consists of medical doctors, natural scientists, administrative staff, and students. To recruit participants, an email invitation was sent to members of the working group. Of 20 eligible persons, 12 women participated. After written consent from participants, individual interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data were analyzed with grounded theory. Findings Participants described a firm organizational culture with persistent, historically grown gendered structures. Potential threat of psychological violence affected mostly “weaker,” less powerful persons, and often women. Descriptions of violence indicated harm to those affected, but intent to harm was doubted. Interventions strengthened the individual, but some participants demanded collective responsibility. Conclusion/application to practice Few descriptions could be classified as psychological violence. Findings indicated a need to change organizational cultures where lower positions pose a potential threat to experiencing harm. Occupational health practice should include training in sensitization to psychological violence, protection of those targeted, deconstructing power accumulation, and promoting diversity in career patterns and working styles.
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Salehi PP, Jacobs D, Suhail-Sindhu T, Judson BL, Azizzadeh B, Lee YH. Consequences of Medical Hierarchy on Medical Students, Residents, and Medical Education in Otolaryngology. Otolaryngol Head Neck Surg 2020; 163:906-914. [DOI: 10.1177/0194599820926105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ObjectiveTo (1) review concepts of medical hierarchy; (2) examine the role of medical hierarchy in medical education and resident training; (3) discuss potential negative impacts of dysfunctional hierarchy in medical and surgical training programs, focusing on otolaryngology; and (4) investigate solutions to these issues.Data SourcesOvid Medline, Embase, GoogleScholar, JSTOR, Google, and article reference lists.Review MethodsA literature search was performed to identify articles relating to the objectives of the study using the aforementioned data sources, with subsequent exclusion of articles believed to be outside the scope of the current work. The search was limited to the past 5 years.ConclusionsTwo types of hierarchies exist: “functional” and “dysfunctional.” While functional medical hierarchies aim to optimize patient care through clinical instruction, dysfunctional hierarchies have been linked to negative impacts by creating learning environments that discourage the voicing of concerns, legitimize trainee mistreatment, and create moral distress through ethical dilemmas. Such an environment endangers patient safety, undermines physician empathy, hampers learning, lowers training satisfaction, and amplifies stress, fatigue, and burnout. On the other hand, functional hierarchies may improve resident education and well-being, as well as patient safety.Implications for PracticeOtolaryngology–head and neck surgery programs ought to work toward creating healthy systems of hierarchy that emphasize collaboration and improvement of workplace climate for trainees and faculty. The goal should be to identify aspects of dysfunctional hierarchy in one’s own environment with the ambition of rebuilding a functional hierarchy where learning, personal health, and patient safety are optimized.
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Affiliation(s)
- Parsa P. Salehi
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Daniel Jacobs
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Timur Suhail-Sindhu
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Benjamin L. Judson
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Babak Azizzadeh
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
- Division of Head and Neck Surgery, Department of Otolaryngology–Head and Neck Surgery, David Geffen School of Medicine at the University of California–Los Angeles, Los Angeles, California, USA
| | - Yan Ho Lee
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Tarras ES, Alpert AB, Kennedy E, Sampson A, Sutter ME, Quinn GP. Protecting Transgender and Gender-Diverse Patients With Cancer in a Shifting Political Landscape. JCO Oncol Pract 2020; 16:287-288. [PMID: 32119594 DOI: 10.1200/jcoop.20.00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ash B Alpert
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Amani Sampson
- New York University School of Medicine, New York, NY
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Mamtani M, Shofer F, Mudan A, Khatri U, Walker R, Perrone J, Aysola J. Quantifying gender disparity in physician authorship among commentary articles in three high-impact medical journals: an observational study. BMJ Open 2020; 10:e034056. [PMID: 32102817 PMCID: PMC7044872 DOI: 10.1136/bmjopen-2019-034056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Scholarship plays a direct role in career advancement, promotion and authoritative recognition, and women physicians remain under-represented as authors of original research articles. OBJECTIVE We sought to determine if women physician authors are similarly under-represented in commentary articles within high-impact journals. DESIGN/SETTING/PARTICIPANTS In this observational study, we abstracted and analysed author information (gender and degree) and authorship position from commentary articles published in three high-impact journals between 1 January 2014 and 16 October 2018. PRIMARY OUTCOME MEASURE Authorship rate of commentary articles over a 5-year period by gender, degree, authorship position and journal. SECONDARY OUTCOME MEASURES To compare the proportion of men and women physician authorship of commentaries relative to the proportion of men and women physician faculty within academic medicine; and to examine the gender concordance among the last and first authors in articles with more than one author. RESULTS Of the 2087 articles during the study period, 48% were men physician first authors compared with 17% women physician first authors (p<0.0001). Of the 1477 articles with more than one author, similar distributions were found with regard to last authors: 55% were men physicians compared with only 12% women physicians (p<0.0001). The proportion of women physician first authors increased over time; however, the proportion of women physician last authors remained stagnant. Women coauthored with women in the first and last authorship positions in 9% of articles. In contrast, women coauthored with men in the first and last author positions, respectively, in 55% of articles. CONCLUSIONS Women physician authors remain under-represented in commentary articles compared with men physician authors in the first and last author positions. Women also coauthored commentaries with other women in far fewer numbers.
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Affiliation(s)
- Mira Mamtani
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances Shofer
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anita Mudan
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Utsha Khatri
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jeanmarie Perrone
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jaya Aysola
- Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Magudia K, Laur O, Robinson-Weiss C, Sahu S, Leonard D, Phillips CH, Smith SE. Women in Radiology: Obtaining Departmental Sponsorship and Building a Sustainable Organization Led by Residents. J Am Coll Radiol 2019; 17:441-443. [PMID: 31843347 DOI: 10.1016/j.jacr.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Kirti Magudia
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
| | - Olga Laur
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Sonia Sahu
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Debra Leonard
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - Catherine H Phillips
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stacy E Smith
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Roy C Ziegelstein
- Johns Hopkins University School of Medicine, Baltimore, Maryland (R.C.Z., D.C.C.)
| | - Deidra C Crews
- Johns Hopkins University School of Medicine, Baltimore, Maryland (R.C.Z., D.C.C.)
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An Exploration of Myths, Barriers, and Strategies for Improving Diversity Among STS Members. Ann Thorac Surg 2019; 108:1617-1624. [DOI: 10.1016/j.athoracsur.2019.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/18/2019] [Indexed: 11/23/2022]
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Schnierle J, Christian-Brathwaite N, Louisias M. Implicit Bias: What Every Pediatrician Should Know About the Effect of Bias on Health and Future Directions. Curr Probl Pediatr Adolesc Health Care 2019; 49:34-44. [PMID: 30738896 PMCID: PMC6652181 DOI: 10.1016/j.cppeds.2019.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Implicit bias has entered modern discourse as a result of our current sociopolitical climate. It is an area that has been largely explored in the social sciences, and was highlighted in the landmark 2003 IOM report, Unequal Treatment, as a contributor to racial/ethnic health disparities. Implicit bias is the process of unconscious societal attitudes affecting our individual understanding, actions and decisions, thus leading to assumptions about groups. Immigrant populations are particularly at risk in our present-day environment, and as a result experience limited healthcare access and higher levels of psychological distress. There are many measures of implicit bias, but the most highly regarded tool is the Implicit Association Test (IAT), as it is valid and reliable. Some level of pro-White/anti-Black bias has been found in most systematic reviews and studies, although there are less studies on bias towards Latinx populations. Limited evidence exists about the association between implicit bias and health outcomes. However, existing publications have demonstrated clear associations between bias and treatment recommendations, nonverbal communication, adverse birth outcomes and provider communication styles. Implicit biases can be unlearned via debiasing strategies, but these have not been examined extensively amongst health care providers. Future research must rely on more than pre- and post-IAT measurements to examine the effect of these strategies on improving patient outcomes. Additionally, healthcare system leadership must prioritize implicit bias trainings for students and medical staff and make greater tangible efforts to improve workforce diversity as a debiasing strategy.
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Affiliation(s)
- Jeanette Schnierle
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Ohio State University College of Medicine, United States
| | | | - Margee Louisias
- Boston Children's Hospital, Division of Allergy and Immunology, 1 Autumn Street, 3rd Floor, Boston, MA 02115, United States; Brigham and Women's Hospital Division of Rheumatology, Immunology and Allergy, United States; Harvard Medical School, United States.
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Aysola J, Harris D, Huo H, Wright CS, Higginbotham E. Measuring Organizational Cultural Competence to Promote Diversity in Academic Healthcare Organizations. Health Equity 2018; 2:316-320. [PMID: 30426110 PMCID: PMC6231484 DOI: 10.1089/heq.2018.0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate what drives respondent perceptions of health system organizational cultural competence. Methods: We estimated associations between survey respondent (n=3506) demographic characteristics, length of employment, position, and place of work and their reported perceptions of institutional culture. Results: In adjusted analyses, respondents self-identifying as non-Hispanic black versus non-Hispanic whites, females versus males, and lesbian/gay/bisexual/transgender/queer versus heterosexuals were significantly less likely to rank the cultural competence of their organization above average. Conclusion: Minorities and women were less likely to rank their organization as culturally competent. Organizational efforts to achieve cultural competency would benefit from measuring this factor to target their efforts.
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Affiliation(s)
- Jaya Aysola
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Associate Designated Institutional Official for Health Equity and Inclusion, Graduate Medical Education, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diana Harris
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hairong Huo
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charmaine S. Wright
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eve Higginbotham
- Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
- Elena Fuentes-Afflick
- Pediatrics, Academic Affairs, University of California, San Francisco, San Francisco, California
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