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Harris M, Lau-Bogaardt T, Shifaza F, Attrill S. The experiences of culturally and linguistically diverse health practitioners in dominant culture practice: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10359-7. [PMID: 39037662 DOI: 10.1007/s10459-024-10359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
Increasing the proportion of culturally and linguistically diverse (CALD) health practitioners is identified as one strategy to address healthcare disparities that individuals from minority or under-represented backgrounds experience. However, professional and institutional cultures and structures are known to contribute to the challenges for CALD practitioners who work in dominant culture practice contexts. This scoping review used the theory of Legitimate Peripheral Participation to describe and interpret literature about the experiences of CALD health practitioners in view of informing strategies to increase their representation. A systematised search was conducted across four allied health, medicine and nursing databases. Following abstract and full text screening, articles which fit the inclusion criteria (n = 124) proceeded to data extraction. Categories relating to the experiences of practitioners were extracted, and three themes were identified that were subsequently theoretically interpreted: Discrimination, Consequences and Hierarchy. Discrimination functioned as a barrier to CALD practitioners being legitimised and able to participate equally in healthcare practice, retaining their position at the periphery of the practice community; Consequences reinforced this peripheral position and further impeded legitimation and participation; and Hierarchy was maintained through structures that reinforced and reproduced these barriers. The findings summarise how these barriers are reinforced through the intersections of professional and racial hierarchies, and highlight a need for strategies to address discrimination and structures that marginalise CALD practitioners' identity, practices and participation in their health professional communities.
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Affiliation(s)
- Mikaela Harris
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Timothea Lau-Bogaardt
- School of Allied Health Science and Practice, The University of Adelaide, Level 4, Engineering Maths and Science Building North Terrace Campus, Adelaide, SA, 5005, Australia
| | - Fathimath Shifaza
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Stacie Attrill
- College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, SA, 5042, Australia.
- School of Allied Health Science and Practice, The University of Adelaide, Level 4, Engineering Maths and Science Building North Terrace Campus, Adelaide, SA, 5005, Australia.
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2
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Yusoff HM, Ahmad H, Ismail H, Reffin N, Chan D, Kusnin F, Bahari N, Baharudin H, Aris A, Shen HZ, Rahman MA. Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review. HUMAN RESOURCES FOR HEALTH 2023; 21:82. [PMID: 37833727 PMCID: PMC10576303 DOI: 10.1186/s12960-023-00868-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
Violence against healthcare workers recently became a growing public health concern and has been intensively investigated, particularly in the tertiary setting. Nevertheless, little is known of workplace violence against healthcare workers in the primary setting. Given the nature of primary healthcare, which delivers essential healthcare services to the community, many primary healthcare workers are vulnerable to violent events. Since the Alma-Ata Declaration of 1978, the number of epidemiological studies on workplace violence against primary healthcare workers has increased globally. Nevertheless, a comprehensive review summarising the significant results from previous studies has not been published. Thus, this systematic review was conducted to collect and analyse recent evidence from previous workplace violence studies in primary healthcare settings. Eligible articles published in 2013-2023 were searched from the Web of Science, Scopus, and PubMed literature databases. Of 23 included studies, 16 were quantitative, four were qualitative, and three were mixed method. The extracted information was analysed and grouped into four main themes: prevalence and typology, predisposing factors, implications, and coping mechanisms or preventive measures. The prevalence of violence ranged from 45.6% to 90%. The most commonly reported form of violence was verbal abuse (46.9-90.3%), while the least commonly reported was sexual assault (2-17%). Most primary healthcare workers were at higher risk of patient- and family-perpetrated violence (Type II). Three sub-themes of predisposing factors were identified: individual factors (victims' and perpetrators' characteristics), community or geographical factors, and workplace factors. There were considerable negative consequences of violence on both the victims and organisations. Under-reporting remained the key issue, which was mainly due to the negative perception of the effectiveness of existing workplace policies for managing violence. Workplace violence is a complex issue that indicates a need for more serious consideration of a resolution on par with that in other healthcare settings. Several research gaps and limitations require additional rigorous analytical and interventional research. Information pertaining to violent events must be comprehensively collected to delineate the complete scope of the issue and formulate prevention strategies based on potentially modifiable risk factors to minimise the negative implications caused by workplace violence.
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Affiliation(s)
- Hanizah Mohd Yusoff
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Hanis Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia.
| | - Halim Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Naiemy Reffin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - David Chan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Faridah Kusnin
- The State of Selangor Health Department, Tingkat 9, 10-11, Wisma 16 Sunway Mas, Lot 1, Jalan Persiaran Kayangan, 40100, Shah Alam, Selangor, Malaysia
| | - Nazaruddin Bahari
- The State of Selangor Health Department, Tingkat 9, 10-11, Wisma 16 Sunway Mas, Lot 1, Jalan Persiaran Kayangan, 40100, Shah Alam, Selangor, Malaysia
| | - Hafiz Baharudin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Azila Aris
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Huam Zhe Shen
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, 56000, Kuala Lumpur, Malaysia
| | - Maisarah Abdul Rahman
- Anaesthesiology Department, Hospital Queen Elizabeth II, Lorong Bersatu Off Jalan Damai, 88300, Kota Kinabalu, Sabah, Malaysia
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Hennein R, Poulin R, Gorman H, Lowe SR. Gender Discrimination and Mental Health Among Health Care Workers: Findings from a Mixed Methods Study. J Womens Health (Larchmt) 2023; 32:823-835. [PMID: 37256783 PMCID: PMC10354310 DOI: 10.1089/jwh.2022.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Background: Gender discrimination among healthcare workers (HCWs) negatively impacts their mental health and career development; however, few studies have explored how experiences of gender discrimination change during times of health system strain. Methods: This survey-based study assesses the associations between gender discrimination and four stress-related mental health outcomes (posttraumatic stress, depression, anxiety, and burnout), as well as the qualitative experiences of gender discrimination in healthcare during the COVID-19 pandemic. Results: Among women, increased gender discrimination was associated with heightened symptoms of posttraumatic stress, depression, anxiety, and burnout after adjusting for demographics and pandemic-related stressors; however, among men, increased gender discrimination was only associated with heightened symptoms of depression. Using thematic analysis, we identified five themes that describe experiences of gender discrimination faced by women in healthcare, including differential valuing of work and contributions, gendered roles and assumptions about roles, maternal discrimination, objectification, and "old boys club." We also identified two themes describing how men perceived gender discrimination, including instances of symbolic discrimination and woman provider preference. Conclusion: These findings suggest that experiences of gender discrimination persist during times of health system strain and negatively impact women HCWs' mental health.
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Affiliation(s)
- Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Rhayna Poulin
- Yale College, Yale University, New Haven, Connecticut, USA
| | - Hannah Gorman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sarah R. Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Saadi A, Taleghani S, Dillard A, Ryan G, Heilemann M, Eisenman D. Original Research: Nurses' Experiences with Racial, Ethnic, Cultural, and Religious Discrimination in the Workplace: A Qualitative Study. Am J Nurs 2023; 123:24-34. [PMID: 37021974 DOI: 10.1097/01.naj.0000931892.39368.e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND As the health care workforce diversifies, understanding and addressing the lived experiences of health care professionals facing prejudice and discrimination becomes increasingly important. Previous studies have focused on physicians and medical trainees, but there remains a dearth of research exploring nurses' experiences-even though nurses make up the largest sector of the nation's health care workforce. OBJECTIVE This qualitative study explored nurses' experiences of personally mediated workplace discrimination based on race, ethnicity, culture, or religion. METHODS We conducted in-depth interviews with a convenience sample of 15 RNs at one academic medical center. Using an inductive thematic analysis approach, we identified several themes emerging from RNs' experiences and responses to a discriminatory event ("encounter"). Themes were grouped across three phases: pre-encounter, encounter, and post-encounter. RESULTS Participants reported wide-ranging experiences, from insensitive joking to overt exclusion, coming from various people including patients, patients' family members, colleagues, and physicians. For many, discrimination was cumulative: similar encounters occurred outside the workplace as well as within the clinical setting, often repeatedly, and were influenced by the sociopolitical context. Participants reported a variety of responses, including emotional reactions such as shock, fear of retaliation, and frustration at being expected to represent one's identity group. Silence or inaction predominated bystander and supervisor responses. Although the encounters themselves were fleeting, their impact was enduring. Early-career encounters were most challenging, and participants grappled internally with lasting effects for years. Long-term effects included avoidance of perpetrators, disconnection from colleagues and their own professional role, and leaving the workplace. CONCLUSIONS The findings illuminate nurses' experiences with racial, ethnic, cultural, and religious discrimination in the workplace. Understanding how such discrimination affects nurses is critical to developing effective responses to encounters, creating safer workplaces, and promoting equity within the profession.
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Affiliation(s)
- Altaf Saadi
- Altaf Saadi is an assistant professor in the Department of Neurology at Harvard Medical School and Massachusetts General Hospital, Boston. Sophia Taleghani is a resident physician in the Department of Medicine and Pediatrics at the David Geffen School of Medicine, University of California, Los Angeles (UCLA). Attallah Dillard is a doctoral student at the UCLA School of Nursing, where MarySue Heilemann is a professor. Gery Ryan is a professor in the Department of Health Systems Science at the Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA. David Eisenman is a professor in the Department of Medicine, UCLA David Geffen School of Medicine, and the Department of Community Health Sciences, UCLA Fielding School of Public Health. Contact author: Altaf Saadi, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Balak N, Shrestha P, Agboola K. The crucial role of ethical hospital administration in neurosurgery education. FRONTIERS IN HEALTH SERVICES 2022; 2:860266. [PMID: 36925839 PMCID: PMC10012789 DOI: 10.3389/frhs.2022.860266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
| | | | - Kayode Agboola
- Department of Neurosurgery, Institute of Neurosurgery, A.P. Romodanov, National Academy of Medical Sciences (NAMS) of Ukraine, Kiev, Ukraine
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Dyrbye LN, West CP, Sinsky CA, Trockel M, Tutty M, Satele D, Carlasare L, Shanafelt T. Physicians' Experiences With Mistreatment and Discrimination by Patients, Families, and Visitors and Association With Burnout. JAMA Netw Open 2022; 5:e2213080. [PMID: 35587344 PMCID: PMC9121189 DOI: 10.1001/jamanetworkopen.2022.13080] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
Importance Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout. Objective To examine the occurrence of mistreatment and discrimination by patients, families, and visitors by physician characteristics and the association between such interactions and experiencing burnout. Design, Setting, and Participants This cross-sectional survey was conducted from November 20, 2020, to March 23, 2021, among US physicians. Exposures Mistreatment and discrimination were measured using items adapted from the Association of American Medical College's Graduation Questionnaire with an additional item querying respondents about refusal of care because of the physicians' personal attributes; higher score indicated greater exposure to mistreatment and discrimination. Main Outcomes and Measures Burnout as measured by the Maslach Burnout Inventory. Results Of 6512 responding physicians, 2450 (39.4%) were female, and 369 (7.2%) were Hispanic; 681 (13.3%) were non-Hispanic Asian, Native Hawaiian, or Pacific Islander; and 3633 (70.5%) were non-Hispanic White individuals. Being subjected to racially or ethnically offensive remarks (1849 [29.4%]), offensive sexist remarks (1810 [28.7%]), or unwanted sexual advances (1291 [20.5%]) by patients, families, or visitors at least once in the previous year were common experiences. Approximately 1 in 5 physicians (1359 [21.6%]) had experienced a patient or their family refusing to allow them to provide care because of the physician's personal attributes at least once in the previous year. On multivariable analyses, female physicians (OR, 2.33; 95% CI, 2.02-2.69) and ethnic and racial minority physicians (eg, Black or African American: OR, 1.59; 95% CI, 1.13-2.23) were more likely to report mistreatment or discrimination in the previous year. Experience of mistreatment or discrimination was independently associated with higher odds of burnout (vs score of 0 [no mistreatment], score of 1: OR, 1.27; 95% CI, 1.04-1.55; score of 2: OR, 1.70; 95% CI, 1.38-2.08; score of 3: OR, 2.20; 95% CI, 1.89-2.57). There was no difference in the odds of burnout by gender after controlling for experiencing mistreatment and discrimination score and other demographic factors, specialty, practice setting, work hours, and frequency of overnight call. Conclusions and Relevance In this study, mistreatment and discrimination by patients, families, and visitors were common, especially for female and racial and ethnic minority physicians, and associated with burnout. Efforts to mitigate physician burnout should include attention to patient and visitor conduct.
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Affiliation(s)
- Liselotte N. Dyrbye
- Mayo Clinic, Rochester, Minnesota
- now with University of Colorado School of Medicine, Denver
| | | | | | - Mickey Trockel
- Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California
| | | | - Daniel Satele
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Holmberg MH, Martin SG, Lunn MR. Supporting sexual and gender minority health-care workers. Nat Rev Nephrol 2022; 18:339-340. [PMID: 35418696 PMCID: PMC9007258 DOI: 10.1038/s41581-022-00573-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mackenzie H Holmberg
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Suzanne G Martin
- Reliant Medical Group, Division of Nephrology, Worcester, MA, USA.,Division of Nephrology, Department of Medicine, St. Vincent Hospital, Worcester, MA, USA
| | - Mitchell R Lunn
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA. .,PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA.
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9
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Douglas PS, Mack MJ, Acosta DA, Benjamin EJ, Biga C, Hayes SN, Ijioma NN, Jay-Fuchs L, Khandelwal AK, McPherson JA, Mieres JH, Roswell RO, Sengupta PP, Stokes N, Wade EA, Yancy CW. 2022 ACC Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace. J Am Coll Cardiol 2022; 79:2153-2184. [DOI: 10.1016/j.jacc.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brodie N, Perdomo JE, Silberholz EA. The dual pandemics of COVID-19 and racism: impact on early childhood development and implications for physicians. Curr Opin Pediatr 2021; 33:159-169. [PMID: 33394742 DOI: 10.1097/mop.0000000000000985] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The novel coronavirus (COVID-19) pandemic has highlighted healthcare and racial inequities. This article discusses recent literature documenting the impact of racism on early childhood development, disparities in access to developmental services and ways healthcare providers and health systems can promote physician well being during these difficult times. RECENT FINDINGS Exposure to racism begins prenatally, and early childhood experiences with racism are intimately tied to adverse physical and mental health outcomes. Early intervention is key to treating children with developmental delay, but disparities exist in accessing eligibility screening and in the provision of services. Paediatric providers are at risk of developing secondary traumatic stress and burnout, which may affect the care that they provide. SUMMARY New research has led to the development of resources that help paediatric providers address racism, access developmental resources in a novel manner and protect the paediatric workforce from trauma and burnout.
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Affiliation(s)
| | - Joanna E Perdomo
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Silberholz
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Vargas EA, Brassel ST, Perumalswami CR, Johnson TRB, Jagsi R, Cortina LM, Settles IH. Incidence and Group Comparisons of Harassment Based on Gender, LGBTQ+ Identity, and Race at an Academic Medical Center. J Womens Health (Larchmt) 2020; 30:789-798. [PMID: 33216670 DOI: 10.1089/jwh.2020.8553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: A key recommendation from the landmark National Academies report called for research examining experiences of underrepresented and/or vulnerable groups, including people of color and sexual- and gender-minority people. We examine the prevalence of gender policing harassment (GPH), heterosexist harassment (HH), and racialized sexual harassment (RSH), by gender, LGBTQ+, race, and department grouping, which has not been previously examined in academic medicine. Materials and Methods: All faculty (n = 2723), fellows, residents, and first through third year medical students (n = 1822) at the University of Michigan Medical School (UMMS) who had been working at the organization for at least 1 year were invited to complete a 20-minute online survey. We assessed harassment within the past year, perpetrated by insiders (i.e., staff, students, and faculty) and from patients and patients' families. Results: A total of 705 faculty (25.9% of the targeted sample) and 583 trainees (32.0% of the targeted sample) were in the analytic sample. Women were significantly more likely to experience GPH from both sources than men, and LGBTQ+ individuals were more likely to face HH from both sources than cisgender heterosexual participants. Underrepresented minorities, Asian/Asian American, and female participants had higher rates of RSH perpetrated by insiders. There were significant department-group differences across harassment types. Conclusions: Less-studied forms of harassment are common within academic medicine and are perpetrated from various sources. Identity-based harassment should be investigated further to gain a comprehensive understanding of its impact within academic medicine. Clinical Trial Registration Number not applicable.
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Affiliation(s)
- Emily A Vargas
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sheila T Brassel
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chithra R Perumalswami
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy R B Johnson
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Women's Studies, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Von Voigtlander Women's Hospital, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lilia M Cortina
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Women's Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Isis H Settles
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Afroamerican and African Studies, University of Michigan, Ann Arbor, Michigan, USA
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12
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Lu DW, Pierce A, Jauregui J, Heron S, Lall MD, Mitzman J, McCarthy DM, Hartman ND, Strout TD. Academic Emergency Medicine Faculty Experiences with Racial and Sexual Orientation Discrimination. West J Emerg Med 2020; 21:1160-1169. [PMID: 32970570 PMCID: PMC7514380 DOI: 10.5811/westjem.2020.6.47123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Despite the increasing diversity of individuals entering medicine, physicians from racial and sexual minority groups continue to experience bias and discrimination in the workplace. The objective of this study was to determine the current experiences and perceptions of discrimination on the basis of race and sexual orientation among academic emergency medicine (EM) faculty. METHODS We conducted a cross-sectional survey of a convenience sample of EM faculty across six programs. Survey items included the Overt Gender Discrimination at Work (OGDW) Scale adapted for race and sexual orientation, and the frequency and source of experienced and observed discrimination. Group comparisons were made using t-tests or chi-square analyses, and relationships between race or sexual orientation, and we evaluated physicians' experiences using correlation analyses. RESULTS A total of 141 out of 352 (40.1%) subjects completed at least a portion of the survey. Non-White physicians reported higher mean racial OGDW scores than their White counterparts (13.4 vs 8.6; 95% confidence interval (CI) for difference, -7.7 - -2.9). Non-White EM faculty were also more likely to report having experienced discriminatory treatment based on race than were White EM faculty (48.0% vs 12.6%; CI for difference, 16.6% - 54.2%), although both groups were equally likely to report having observed race-based discrimination of another physician. EM faculty who identified as sexual minorities reported higher mean sexual minority OGDW scores than their heterosexual counterparts (11.1 vs 7.1; 95% CI for difference, -7.3 - -0.6). There were no significant differences between sexual minority and heterosexual faculty in their reports of experiencing or observing discrimination based on sexual orientation. CONCLUSION EM faculty from racial and sexual minority groups perceived more discrimination based on race or sexual orientation in their workplace than their majority counterparts. EM faculty regardless of race or sexual orientation were similar in their observations of discriminatory treatment of another physician based on race or sexual orientation.
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Affiliation(s)
- Dave W Lu
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Ava Pierce
- University of Texas Southwestern Medical School, Department of Emergency Medicine, Dallas, Texas
| | - Joshua Jauregui
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Sheryl Heron
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Michelle D Lall
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Jennifer Mitzman
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Danielle M McCarthy
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Nicholas D Hartman
- Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Tania D Strout
- Tufts University School of Medicine - Maine Medical Center, Department of Emergency Medicine, Portland, Maine
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Pathman D. Are Bias, Harassment, and Discrimination by Physician-Peers a Reason Why Some Physicians Leave Rural Communities? JAMA Netw Open 2019; 2:e1913540. [PMID: 31642922 DOI: 10.1001/jamanetworkopen.2019.13540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Donald Pathman
- Department of Family Medicine, University of North Carolina at Chapel Hill
- Program on Primary Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
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