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.

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.