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Kaplan KB, Tenam-Zemach M, Reeves J. Improving cultural humility in physical therapy students: What is faculty's role? Physiother Theory Pract 2024; 40:2380-2397. [PMID: 37647271 DOI: 10.1080/09593985.2023.2252053] [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: 04/17/2023] [Revised: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Clinician bias contributes to health disparities; therefore, educational standards and professional expectations incorporate cultural humility. Vague standards and numerous pedagogical methods make implementing an effective and uniform curriculum challenging. Classroom and clinical faculty's attitudes and behaviors are pivotal; however, evidence on roles beyond instruction is lacking. PURPOSE This study explored physical therapy (PT) students' perceptions of faculty's role in improving their cultural humility. METHODS This study was rooted in a phenomenological approach that incorporated elements of both descriptive and interpretive phenomenology. Thirteen first-year PT students participated in one-on-one interviews which underwent reflexive thematic analysis. RESULTS Reflexive thematic analysis generated two hundred-ninety codes, six categories, and one overarching theme. Dissonance emerged between students' perceptions of faculty's role and the explicit and implicit curriculum. CONCLUSION Explicit messaging from classroom instruction and implicit messaging from clinical encounters and unspoken attitudes, values, and behaviors were disparate. Faculty role modeling, diversity, cultural awareness, and perceived comfort interacting with a diverse patient population improved students' self-confidence and cultural humility. Professional development including field experience with a cognitive apprenticeship approach, and standardized, discipline-specific cultural humility competencies may provide uniform and clear guidelines.
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Affiliation(s)
- Kelby B Kaplan
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, Baltimore, MD, United States
| | - Michelle Tenam-Zemach
- Fischler College of Education, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jennifer Reeves
- Fischler College of Education, Nova Southeastern University, Fort Lauderdale, FL, United States
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Liu Y, Frazier PA. The Role of the COVID-19 Pandemic and Marginalized Identities in US Medical Students' Burnout, Career Regret, and Medical School Experiences. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10045-1. [PMID: 39242464 DOI: 10.1007/s10880-024-10045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/09/2024]
Abstract
Little is known about the impact of the COVID-19 pandemic on medical students. We examined medical students' burnout, career regret, and medical school experiences from before to during the pandemic, and differences between students from marginalized and nonmarginalized groups. We analyzed data from 2019 to 2022 Association of American Medical Colleges Year Two Questionnaires (N = 52,152) and Graduation Questionnaires (N = 66,795). Given large samples, we focused on effect sizes versus statistical significance. All effects of study year were less than small (η2 < .01) indicating minimal differences in medical students' burnout, career regret, and school experiences from before (2019) to during (2020-2022) the pandemic. Interactions between study year and demographic characteristics (gender, race-ethnicity, sexual orientation) were less than small; thus, students from marginalized groups were not affected more by the pandemic than others. Across study years, women reported more exhaustion and discrimination than men. Black students reported more discrimination than students from other racial-ethnic groups; bisexual students reported more discrimination than heterosexual students (all ds > 0.20). Differences between students from marginalized and nonmarginalized groups were bigger than the effects of the pandemic, suggesting a need for system-level interventions to foster inclusion in medical education.
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Affiliation(s)
- Yuchen Liu
- Department of Psychology, University of Minnesota-Twin Cities, 75 East River Road, N218 Elliott Hall, Minneapolis, MN, 55455, USA
| | - Patricia A Frazier
- Department of Psychology, University of Minnesota-Twin Cities, 75 East River Road, N218 Elliott Hall, Minneapolis, MN, 55455, USA.
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3
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Nemiroff S, Blanco I, Burton W, Fishman A, Joo P, Meholli M, Karasz A. Moral injury and the hidden curriculum in medical school: comparing the experiences of students underrepresented in medicine (URMs) and non-URMs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:371-387. [PMID: 37382857 DOI: 10.1007/s10459-023-10259-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
Underrepresented students in medicine (URM) have more negative perceptions of the medical school learning environment (LE), a phenomenon that can contribute to higher rates of burnout and attrition in these populations. The hidden curriculum (HC)-defined as a set of values informally conveyed to learners through clinical role-modeling-is a LE socialization construct that has been critically examined for its role in shaping students' professional identities. Yet differences in how URMs and non-URMs experience the HC remain underexplored. The study used a pragmatic approach that drew on elements of grounded theory and employed both deductive and inductive reasoning. Investigators conducted qualitative, semi-structured interviews with a purposive sample of 13 URM and 21 non-URM participants at a Bronx, NY medical school. Interviews examined student experiences and reactions to the HC. Both cohorts witnessed patient disparagement and mistreatment. However, from these encounters, URM participants expressed more moral injury-the adverse emotional consequence of feeling pressured to accept ideologically incongruent values. URMs were also more likely to describe resisting the HC. Differences in group reactions appeared to arise from URMs' identity resonance with patients' lived experiences. Participants across cohorts emphasized increasing URM recruitment as one step toward mitigating these circumstances. URM participants experienced more distress and offered more resistance to the HC relative to non-URMs. The etiology of these differential reactions may stem from relative barriers in negotiating personal and professional identities. As such, URMs' perceptions of the LE may be adversely impacted given their more negative interactions with the HC.
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Affiliation(s)
- Samuel Nemiroff
- Albert Einstein College of Medicine, New York City, NY, USA.
- Mount Sinai Morningside-West, New York City, USA.
| | - Irene Blanco
- Medicine-Rheumatology, Clinical Research Ethics & Equity Consultative Service (CREEC), Northwestern University, Chicago, IL, USA
| | - William Burton
- Assessment, Evaluation and Quality Improvement in the Office of Medical Education, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ariel Fishman
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pablo Joo
- Department of Family Medicine, University of California, Riverside, CA, USA
| | - Mimoza Meholli
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alison Karasz
- Department of Family Medicine and Community Health, Chan Medical School, University of Massachusetts, Worcester, MA, USA
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Danckers M, Nusynowitz J, Jamneshan L, Shalmiyev R, Diaz R, Radix AE. The sexual and gender minority (LGBTQ+) medical trainee: the journey through medical education. BMC MEDICAL EDUCATION 2024; 24:67. [PMID: 38233849 PMCID: PMC10795322 DOI: 10.1186/s12909-024-05047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
In this literature overview, we share with the reader challenges faced by LGBTQ + individuals pursuing medical education, from undergraduate to postgraduate training. The LGBTQ + acronym has evolved to encompass the diverse spectrum of sexual orientation and gender identities. Recently, the term "Sexual and Gender Minority" (SGM) has emerged as an umbrella term to provide consistency in research advancing SGM health. The unique obstacles LGBTQ + trainees encounter are highlighted throughout this article, including external factors influencing career decisions, a lack of LGBTQ + healthcare curricula, discriminatory social interactions, limited mentorship opportunities, and a higher mental health burden. These challenges have the capacity to affect educational experiences, personal well-being, and professional growth. Additionally, we examine the impact of inclusive institutional climates on LGBTQ + trainees' selection of medical schools and residency programs, as they may prioritize inclusiveness and diversity when making their choice. In postgraduate training, LGBTQ + trainees continue to face challenges, exemplified by disparities in placement rates and discriminatory experiences based on sexual orientation and gender identity. We describe the gap in current research and its long-term impact of these challenges on career paths. Hostile environments persist in certain specialties, and the lack of LGBTQ + mentorship and support can hinder academic pursuits. We shed light on the unique and pervasive challenges faced by LGBTQ + trainees throughout their medical education journey, while emphasizing the need for inclusive policies, support systems, and research to address these challenges. With increasing research and studies, we hope to create a medical workforce and community that better represents the diverse communities it serves.
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Affiliation(s)
- Mauricio Danckers
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA.
| | - Jake Nusynowitz
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Lily Jamneshan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Richard Shalmiyev
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Raiko Diaz
- Division of Pulmonary and Critical Care Medicine, HCA Florida Aventura Hospital, Aventura, FL, USA
| | - Asa E Radix
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
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Sorgini A, Istl AC, Downie ML, Kirpalani A. Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. MEDICAL TEACHER 2024; 46:73-81. [PMID: 37418565 DOI: 10.1080/0142159x.2023.2229503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees. METHODS We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus. RESULTS From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population. CONCLUSION This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.
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Affiliation(s)
- Alana Sorgini
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra C Istl
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London, UK
- Department of Nephrology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Nephrology, Children's Hospital, London Health Sciences Centre, London, ON, Canada
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Hubbard A, Sudler A, Alves-Bradford JME, Trinh NH, Emmerich AD, Mangurian C. Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors. Child Adolesc Psychiatr Clin N Am 2024; 33:57-69. [PMID: 37981337 DOI: 10.1016/j.chc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.
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Affiliation(s)
- Asale Hubbard
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA; San Francisco VA Health Care System
| | - Andrew Sudler
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA
| | | | - Nhi-Ha Trinh
- Massachusetts General Hospital Department of Psychiatry
| | | | - Christina Mangurian
- University of California, San Francisco Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, 675 18th Street, San Francisco, CA 94107, USA.
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Iwai Y, Yu AYL, Thomas SM, Downs-Canner S, Beasley GM, Sudan R, Fayanju OM. At the Intersection of Intersectionality: Race and Gender Diversity Among Surgical Faculty and Trainees. Ann Surg 2024; 279:77-87. [PMID: 37436874 PMCID: PMC10787047 DOI: 10.1097/sla.0000000000005992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To compare the representation of intersectional (ie, racial/ethnic and gender) identities among surgical faculty versus medical students. BACKGROUND Health disparities are pervasive in medicine, but diverse physicians may help the medical profession achieve health equity. METHODS Data from the Association of American Medical Colleges for 140 programs (2011/2012-2019/2020) were analyzed for students and full-time surgical faculty. Underrepresented in medicine (URiM) was defined as Black/African American, American Indian/Alaskan Native, Hispanic/Latino/Spanish Origin, or Native Hawaiian/Other Pacific Islander. Non-White included URiM plus Asian, multiracial, and non-citizen permanent residents. Linear regression was used to estimate the association of year and proportions of URiM and non-White female and male faculty with proportions of URiM and non-White students. RESULTS Medical students were comprised of more White (25.2% vs 14.4%), non-White (18.8% vs 6.6%), and URiM (9.6% vs 2.8%) women and concomitantly fewer men across all groups versus faculty (all P < 0.01). Although the proportion of White and non-White female faculty increased over time (both P ≤ 0.001), there was no significant change among non-White URiM female faculty, nor among non-White male faculty, regardless of whether they were URiM or not. Having more URiM male faculty was associated with having more non-White female students (estimate = +14.5% students/100% increase in faculty, 95% CI: 1.0% to 8.1%, P = 0.04), and this association was especially pronounced for URiM female students (estimate = +46.6% students/100% increase in faculty, 95% CI: 36.9% to 56.3%, P < 0.001). CONCLUSIONS URiM faculty representation has not improved despite a positive association between having more URiM male faculty and having more diverse students.
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Affiliation(s)
- Yoshiko Iwai
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alice Yunzi L Yu
- Department of Pediatrics, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Stephanie Downs-Canner
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Georgia M Beasley
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Ranjan Sudan
- Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Oluwadamilola M Fayanju
- Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
- Breast Surgery, Rena Rowan Breast Center, Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Health Equity Innovation, Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA
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8
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Karasz A, Nemiroff S, Joo P, Blanco I, Fishman AY, Kelly MS, Henick SM, Lambros M, Burton WB. A Sense of Belonging: Perceptions of the Medical School Learning Environment among URM and Non-URM Students. TEACHING AND LEARNING IN MEDICINE 2023:1-11. [PMID: 37450615 DOI: 10.1080/10401334.2023.2232347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/08/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
Phenomenon: Improving the learning environment (LE), particularly for students underrepresented in medicine (URM), has become an important goal for institutions that provide undergraduate and graduate medical education. Until recently, research and intervention development have been limited by the lack of comprehensive theoretical frameworks. A multi-dimensional conceptual model of the medical school environment, developed by Gruppen and colleagues in 2019, provides a useful framework for guiding research and interventions in this area.Approach: Using Gruppen et al's model, this study investigated experiences of the LE from the perspectives of both URM and non-URM students at a medical school in New York City. In examining experiences of the organizational, social, and physical domains of the LE, we sought to explore the symbolic and experiential links across domains and identify concrete needs for improvement.Findings: Institutional structures and policies, features of the built environment, and social relationships that put learning first and generated a sense of community were highly valued. Although both URM and non-URM students shared many perceptions and experiences, URM students expressed heightened vulnerability to the experiences of devaluation and exclusion.Insights: All participants in the study greatly appreciated aspects of the LE that made them feel like valued members of the community. Medical schools should approach the task of improving the LE for URM students using a comprehensive, multi-dimensional approach.
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Affiliation(s)
- Alison Karasz
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Samuel Nemiroff
- Albert Einstein College of Medicine, Mount Sinai Morningside-West, New York, New York, USA
| | - Pablo Joo
- Department of Family Medicine, University of California at Riverside, Riverside, California, USA
| | - Irene Blanco
- Department of Medicine-Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ariel Y Fishman
- Institutional Research, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mary S Kelly
- Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven M Henick
- Albert Einstein College of Medicine and currently an orthopedic surgery resident, Montefiore Medical Center, Bronx, New York, USA
| | - Maryl Lambros
- Albert Einstein College of Medicine and currently a bioinformatics scientist, Avista Therapeutics, Pittsburgh, Pennsylvania, USA
| | - William B Burton
- Assessment, Evaluation, and Quality Improvement in the Office of Medical Education, Albert Einstein College of Medicine, Bronx, New York, USA
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Nguyen M, Chaudhry SI, Desai MM, Chen C, Mason HRC, McDade WA, Fancher TL, Boatright D. Association of Sociodemographic Characteristics With US Medical Student Attrition. JAMA Intern Med 2022; 182:917-924. [PMID: 35816334 PMCID: PMC9274446 DOI: 10.1001/jamainternmed.2022.2194] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Diversity in the medical workforce is critical to improve health care access and achieve equity for resource-limited communities. Despite increased efforts to recruit diverse medical trainees, there remains a large chasm between the racial and ethnic and socioeconomic composition of the patient population and that of the physician workforce. Objective To analyze student attrition from medical school by sociodemographic identities. Design, Setting, and Participants This retrospective cohort study included allopathic doctor of medicine (MD)-only US medical school matriculants in academic years 2014-2015 and 2015-2016. The analysis was performed from July to September 2021. Main Outcomes and Measures The main outcome was attrition, defined as withdrawal or dismissal from medical school for any reason. Attrition rate was explored across 3 self-reported marginalized identities: underrepresented in medicine (URiM) race and ethnicity, low income, and underresourced neighborhood status. Logistic regression was assessed for each marginalized identity and intersections across the 3 identities. Results Among 33 389 allopathic MD-only medical school matriculants (51.8% male), 938 (2.8%) experienced attrition from medical school within 5 years. Compared with non-Hispanic White students (423 of 18 213 [2.3%]), those without low income (593 of 25 205 [2.3%]), and those who did not grow up in an underresourced neighborhood (661 of 27 487 [2.4%]), students who were URiM (Hispanic [110 of 2096 (5.2%); adjusted odds ratio (aOR), 1.41; 95% CI, 1.13-1.77], non-Hispanic American Indian/Alaska Native/Native Hawaiian/Pacific Islander [13 of 118 (11.0%); aOR, 3.20; 95% CI, 1.76-5.80], and non-Hispanic Black/African American [120 of 2104 (5.7%); aOR, 1.41; 95% CI, 1.13-1.77]), those who had low income (345 of 8184 [4.2%]; aOR, 1.33; 95% CI, 1.15-1.54), and those from an underresourced neighborhood (277 of 5902 [4.6%]; aOR, 1.35; 95% CI, 1.16-1.58) were more likely to experience attrition from medical school. The rate of attrition from medical school was greatest among students with all 3 marginalized identities (ie, URiM, low income, and from an underresourced neighborhood), with an attrition rate 3.7 times higher than that among students who were not URiM, did not have low income, and were not from an underresourced neighborhood (7.3% [79 of 1086] vs 1.9% [397 of 20 353]; P < .001). Conclusions and Relevance This retrospective cohort study demonstrated a significant association of medical student attrition with individual (race and ethnicity and family income) and structural (growing up in an underresourced neighborhood) measures of marginalization. The findings highlight a need to retain students from marginalized groups in medical school.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Chronic Disease Epidemiology Department, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Candice Chen
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - William A. McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, Geriatrics and Bioethics, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Malek R, Shibli-Rahhal A, Correa R, Szmuilowicz ED, Morgan F, Luthra P, Sirisena I, Gianoukakis A, Praw SS, Lieb DC, Haw JS, Mayson SE. An Assessment of Diversity, Inclusion, and Health Equity Training in Endocrinology Fellowship Programs in the United States. Endocr Pract 2022; 28:1159-1165. [PMID: 35985561 DOI: 10.1016/j.eprac.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT The ACGME has instituted common program requirements related to diversity, equity, and inclusion (DEI) for post-graduate trainees in the United States; however, the extent to which DEI training is being incorporated across endocrinology fellowship programs is unknown. OBJECTIVES Describe the socio-demographic representation, and DEI training experiences within endocrinology fellowship programs. DESIGN, SETTING AND PARTICIPANTS National cross-sectional survey study of fellows and fellowship program leaders in the United States whose fellowships were members of the Association of Program Directors in Endocrinology and Metabolism (APDEM). MAIN OUTCOME MEASURES 1) Demographics of fellows and program leaders. 2) Programs' experience, confidence, and interest in formal DEI training. RESULTS A total of 108 and 106 fellow and faculty respectively responded to the survey, respectively. The majority of fellows and faculty are female. Less than 3% of fellows and 3.7% of faculty identify as Black. More than 90% of fellows/faculty are heterosexual and no respondents identified as transgender/non-binary; however, 5% and 2% of all respondents preferred not to disclose their sexual orientation and gender identity, respectively. While 85% of faculty received institutional diversity and inclusion training, 67.6% of fellows did. Fellows are more likely to have received training in health equity than program leaders. Both fellows and program leaders express a high interest in health equity curriculum. CONCLUSIONS Within the diversity of endocrinology training programs, Black physicians are under-represented in medicine, which persists in endocrinology fellowships. Fellowship programs express enthusiasm for national diversity and health equity curricula with the majority of programs reporting institutional DEI training.
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Affiliation(s)
- Rana Malek
- Division of Endocrinology, Diabetes, and Nutrition. University of Maryland School of Medicine, Baltimore, MD.
| | - Amal Shibli-Rahhal
- Division of Endocrinology, Diabetes and Metabolism, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Ricardo Correa
- Division of Endocrinology, Metabolism and Diabetes, University of Arizona College of Medicine, Phoenix, AZ
| | - Emily D Szmuilowicz
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Farah Morgan
- Division of Endocrinology, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ
| | - Pooja Luthra
- Division of Endocrinology, Diabetes and Metabolism, UConn Health, Farmington, CT
| | - Imali Sirisena
- Division of Endocrinology, Diabetes and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Andrew Gianoukakis
- The Lundquist Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA
| | - Stephanie Smooke Praw
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David C Lieb
- Division of Endocrine and Metabolic Conditions, Department of Internal Medicine, Eastern Virginia Medical School Norfolk, VA
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA
| | - Sarah E Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO
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Dellasega C, Aruma JF, Sood N, Andreae DA. The Impact of Patient Prejudice on Minoritized Female Physicians. Front Public Health 2022; 10:902294. [PMID: 35865248 PMCID: PMC9294398 DOI: 10.3389/fpubh.2022.902294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/10/2022] [Indexed: 01/14/2023] Open
Abstract
Background Patient bias and prejudice directed against physicians from diverse backgrounds is a frequent occurrence in healthcare. Female physicians have long experienced discrimination in the healthcare system based on their gender alone. The dynamic known as Patient Prejudice toward Providers (PPtP) is disproportionately affecting female physicians because it is frequently compounded by sexism. Aim The goal of this study was to explore the impact of PPtP on female resident and attending physicians. Methods Using transcribed one-on-one interviews from a larger study of PPtP affecting resident and attending physicians, ten interviews with female physicians (resident and attending) from diverse ethnic backgrounds and countries of training at a large academic medical center were analyzed. The authors independently reviewed the interviews using an iterative process within and across interviews to inductively identify repeating words, phrases, and concepts relevant to the study aim. Results Demographics of the ten participants included age (mean 34.6 years), ethnicity (6 Asian, 2 Hispanic, 2 African), and country of training (10% IMG vs. 90% US trained). Four of the interviewees were residents and six were attendings. Themes that emerged from the analysis included experiencing "A Gendered Continuum of Abuse," "Establishing a Higher Standard of Competency," "Overcoming the Stereotype of the White Male Physician," "The Physicality of Self Identity," and "The Need to be Protective of Minoritized Trainees." All participants agreed that these perceptions created an adverse environment at the workplace and impacted on patient care. Conclusions Discrimination of physicians based on their gender or their race/ethnicity has been reported. This study highlights the compounded effects of patient prejudice on female minoritized physicians. Organizations and individuals should identify and implement strategies to address the impact of PPtP and sexism in order to create an environment where all women can thrive professionally.
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Affiliation(s)
- Cheryl Dellasega
- Department of Humanities, Penn State College of Medicine, Hershey, PA, United States
| | | | - Natasha Sood
- Penn State College of Medicine, Hershey, PA, United States
| | - Doerthe A. Andreae
- Division of Allergy and Immunology, Department of Dermatology, University of Utah, Salt Lake, UT, United States,*Correspondence: Doerthe A. Andreae
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Building a Diverse Psychiatric Workforce for the Future and Helping Them Thrive: Recommendations for Psychiatry Training Directors. Psychiatr Clin North Am 2022; 45:283-295. [PMID: 35680244 PMCID: PMC9399901 DOI: 10.1016/j.psc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.
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Faro JM, Pbert L, Crawford S, Frisard CF, Pendharkar JA, Sadasivam RS, Geller AC, Mazor KM, Ockene JK. U.S. medical students personal health behaviors, attitudes and perceived skills towards weight management counseling. Prev Med Rep 2022; 27:101814. [PMID: 35656208 PMCID: PMC9152782 DOI: 10.1016/j.pmedr.2022.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/28/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
Physicians' abilities to address obesity in routine care may be affected by their own health behaviors, skills in and attitudes toward weight management counseling (WMC). Gender differences have been noted amongst these factors as well. We examined gender differences in personal health behaviors and predictors of perceived WMC skills and attitudes of medical students enrolled in a WMC trial. Enrollment took place in 2020 and consisted of students from eight U.S. medical schools. Baseline measures included demographics, exercise, and weight management behaviors, WMC attitudes and perceived skills. Descriptive statistics were calculated, and linear mixed models used to assess the effect of personal health behaviors on outcomes of WMC attitudes and perceived skills. Complete data were available for 1145 medical students. More males reported exercising 4 or more days/week (58.6% v. 41.4%), being more likely to monitor their weight (75.6% v. 70.3%) and less likely to intentionally attempt weight loss in the past (50.3% v. 65.3%) compared to females (all p's < 0.05). Exercising 4 or more days per week was positively associated with perceived WMC skills in the adjusted model (β = 0.10, CI 0.06 to 0.14, p < 0.01). Exercise frequency was positively associated with perceived WMC skills, regardless of gender. WMC curriculum may consider focusing on personal health behaviors such as exercise to increase perceived WMC skills.
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Affiliation(s)
- Jamie M. Faro
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
- Corresponding author.
| | - Lori Pbert
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Sybil Crawford
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Christine F. Frisard
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Jyothi A. Pendharkar
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Rajani S. Sadasivam
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Alan C. Geller
- Harvard School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Ave., Cambridge, MA, United States
| | - Kathleen M. Mazor
- Meyers Health Care Institute, University of Massachusetts Medical School, 385 Grove St., Worcester, MA, United States
- University of Massachusetts Chan Medical School, Department of Medicine, 55 N Lake Ave., Worcester, MA, United States
| | - Judith K. Ockene
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
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Teklu Y, Bell M, Saunders IM, Abdul‐Mutakabbir JC. Diversifying the clinical pipeline: The necessity of diverse, equitable, and inclusive initiatives to advance the placement of underrepresented minoritized students in postgraduate pharmacy training. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yodit Teklu
- Department of Pharmacy VA Greater Los Angeles Healthcare System Los Angeles California USA
| | - Maya Bell
- Department of Pharmacy University of Minnesota Medical Center Minneapolis Minnesota USA
| | - Ila M. Saunders
- UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences La Jolla California USA
| | - Jacinda C. Abdul‐Mutakabbir
- Department of Pharmacy Practice Loma Linda School of Pharmacy Loma Linda California USA
- Department of Basic Sciences Loma Linda University School of Medicine Loma Linda California USA
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