Equity, diversity, and…exclusion? A national mixed methods study of "belonging" in Canadian undergraduate medical education

The Relationship between Burnout and Sense of School Belonging among the Resident Physicians in the Standardization Training in China

BACKGROUND

As an important part in medical training in graduate school, 33-month medical residency training could be a stressful period inducing burnout (i.e. emotional exhaustion, depersonalization, and low personal accomplishment). Despite that existing literature has found that sense of belonging may have merits for residents' well-being, it has remained unclear how sense of school belonging affects burnout and the potential moderators. To address this question, a cross-sectional survey has been conducted among the residents of the physicians standardized residency training program in China.

METHODS

Seven hundred (N = 700) resident physicians from different majors (i.e. clinical medicine, clinical Stomatology, and Chinese medicine) and grades have participated in the survey. Resident's sense of school belonging was assessed with the psychological sense of school membership scale (PSSM, mean = 45.12, SD = 11.14). Burnout was measured by the 22-item Maslach Burnout Inventory (MBI-HSS, mean = 65.80, SD = 15.89), including three subscales of emotional exhaustion, depersonalization, and personal accomplishment.

RESULTS

The results showed that over 80% of the residents reported moderate or high level of emotional exhaustion and reduced personal accomplishment during residency training. Meanwhile, higher level of sense of school belonging was associated with lower overall burnout (B = -0.722, p < 0.001), less emotional exhaustion, reduced depersonalization, and higher personal accomplishment. In particular, the benefits of sense of belonging seem more pronounced among female and those at earlier stage of residency. No interaction effect was found between sense of belonging and major, while those from Chinese medicine reported lower scores in overall burnout and the three dimensions.

CONCLUSIONS

Burnout was a prevalent issue among the resident physicians, and our findings confirmed the protective effects of sense of school belonging against burnout. Therefore, support service should be developed to cultivate resident's sense of school belonging and social connections, particularly for female and those at earlier stage of residency.

Impact of diversity representation in art on pre-health professions students' sense of belonging: A randomized experimental study

BACKGROUND

For learners underrepresented in medicine (UIM), a heightened sense of belonging may be critical to creating shared awareness of diversity and fostering an inclusive educational environment. Despite ongoing efforts from academic medical institutions to promote and retain diverse individuals, few studies have investigated the foundational role of pre-health professions education in shaping students' sense of belonging, and fewer still have leveraged the potential of arts- and humanities-based approaches in doing so. This study aimed to evaluate the perceived impact of race- and gender-diverse visual representations of health professionals on pre-health students' sense of belonging.

METHODS

Twenty-eight pre-health professions students at one large undergraduate academic institution were randomized to one of two study groups. Each group participated in a visual arts-based workshop to discuss images depicting either gender- and race-diverse or non-diverse health professionals. All participants completed a pre- and post-workshop survey consisting of select items from the Professional Identity Questionnaire (PIQ), as well as an additional open-ended survey after viewing the images from the other study group. Changes in PIQ item scores were analyzed using chi-square statistics, and free-text survey responses underwent thematic analysis.

RESULTS

Although PIQ item score changes were not statistically significant in either group, both showed an overall directional increase that was more pronounced in the study group exposed to diverse images. Qualitative analysis of responses to open-ended survey items were grouped into four overarching themes: "Diversity, equity, and inclusion (DEI) converges with other aspects of intersectional identity," "sense of belonging drives motivation," "perceptions of medicine are shaped early in training," and "cross-group exposure stimulates metacognitive thinking."

CONCLUSION

Integrating arts and humanities programming into pre-health professions education may help cultivate a sense of belonging among UIM students, providing a robust platform for the critical dialogues essential in advancing inclusivity within healthcare settings.

Together but separate: a longitudinal study of how spatial context shapes the formation of social ties of women medical students

Developing and maintaining connections with others, or what we refer to as the formation of social ties, may strengthen medical students' sense of belonging in medical school. Social ties play a particularly important role for women medical students as the medical field remains largely dominated by masculine norms. However, forming social ties remains challenging for women in medicine. This study used the COVID-19 pandemic to examine how women medical students navigated the spatial contexts of medical school to form social ties. Using longitudinal qualitative research and narrative inquiry, it describes how 17 women medical students formed social ties during the early stages of COVID-19. Beginning in fall 2020, during the initial two-years of medical school, the participants (1) described how personal ties were deterred from forming in early experiences of medical school; (2) shared experiences that promoted a sense of community bonding during middle and later periods; and (3) expressed limitations of access to the formation of professional ties throughout their initial 2-years. This study has important implications for understanding ways spatial contexts, access to physical connections, and the mental and emotional barriers or pathways play roles in social tie formation for women medical students and how longitudinal qualitative research can narrate these changes through time.

Patterns of Ostracism Experienced by Canadian Medical Trainees of Asian Sub-ethnicities

Phenomenon: Ostracism has negative effects on one's fundamental needs. North Americans of Asian ethnicities are at an increased risk of ostracism due to stereotypes labeling them as inherently different to Western cultural norms. We explored Asian Canadian medical trainees' experiences with ostracism during their clinical training. Approach: We conducted semi-structured interviews with 20 medical trainees of Asian ethnicities at 3 Canadian medical schools to explore experiences of ostracism and conducted a thematic analysis guided by the theoretical framework of the temporal need threat model of ostracism. Findings: Participants from East-, South-, and Southeast-Asian sub-ethnic groups completed the study. They voiced experiences of being excluded from clinical and social settings. Ostracism was mainly fueled by systemic racism, power dynamics in medical education, and non-diverse training environments. The model minority myth was a significant contributor to experiences of ostracism. Trainees felt their well-being threatened and many felt resigned to accept ostracism going forward. Insights: Ostracism poses a significant threat to the wellbeing and career progression of Asian Canadian medical trainees. Trainees facing covert ostracism were particularly at risk of entering the resignation stage of hopelessness. This underrecognized problem needs to be addressed by institutions to dismantle harmful stereotypes and prejudiced practices facing these minoritized communities.