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Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
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Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
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2
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Zelin NS, Scott C, Avila-Quintero VJ, Curlin K, Flores JM, Bloch MH. Sexual Orientation and Racial Bias in Relation to Medical Specialty. JOURNAL OF HOMOSEXUALITY 2024; 71:574-599. [PMID: 36269161 DOI: 10.1080/00918369.2022.2132441] [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: 06/16/2023]
Abstract
Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.
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Affiliation(s)
| | - Carter Scott
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaveri Curlin
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Jose M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, 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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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [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: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Lelutiu-Weinberger C, Clark KA, Pachankis JE. Mental Health Provider Training to Improve LGBTQ Competence and Reduce Implicit and Explicit Bias: A Randomized Controlled Trial of Online and In-Person Delivery. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2023; 10:589-599. [PMID: 38239562 PMCID: PMC10794005 DOI: 10.1037/sgd0000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals in most countries face strong stigma and often rely on affirmative mental health care to foster coping and resilience. We tested an LGBTQ-affirmative mental health training for psychologists and psychiatrists by comparing in-person versus online modalities and the added benefit of supervision. Participants were randomized to a two-day training either in-person (n = 58) or via live-stream online broadcast (n = 55). Outcomes were assessed at baseline and 5, 10, and 15 months posttraining. Optional monthly online supervision was offered (n = 47) from months 5 to 15. Given the substantial need for LGBTQ-affirmative expertise in high-stigma contexts, the training took place in Romania, a Central-Eastern European country with some of the highest LGBTQ stigma in Europe. Participants (M age = 35.1) were mostly cisgender female (88%) and heterosexual (85%). Trainees, regardless of whether in-person or online, reported significant decreases from baseline to 15-month follow-up in implicit and explicit bias and significant increases in LGBTQ-affirmative clinical skills, beliefs, and behaviors. LGBTQ-affirmative practice intentions and number of LGBTQ clients did not change. Participants who attended at least one supervision session demonstrated greater reductions in explicit bias and increases in LGBTQ-affirmative behaviors from baseline to 15-month follow-up than participants who did not attend supervision. LGBTQ-affirmative mental health training can efficiently and sustainably improve LGBTQ competence and reduce provider bias in high-stigma contexts. Future research can identify additional ways to encourage mental health providers' outreach to LGBTQ clients in need of affirmative care.
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Affiliation(s)
- Corina Lelutiu-Weinberger
- Rutgers Biomedical and Health Sciences, School of Nursing, Rutgers, the State University of New Jersey
| | - Kirsty A. Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
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6
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Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6569. [PMID: 37623155 PMCID: PMC10454622 DOI: 10.3390/ijerph20166569] [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: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.
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Affiliation(s)
- Ursula Meidert
- School of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (G.D.); (T.B.); (F.W.); (A.G.-G.)
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7
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Koh EYH, Koh KK, Renganathan Y, Krishna L. Role modelling in professional identity formation: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:194. [PMID: 36991373 PMCID: PMC10052869 DOI: 10.1186/s12909-023-04144-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP). METHODS A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices. RESULTS 12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences. CONCLUSION Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.
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Affiliation(s)
- Eugene Yong Hian Koh
- Singapore Armed Forces, 303 Gombak Drive, Singapore, 669645, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Kai Kee Koh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Yaazhini Renganathan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Duke-NUS Medical School, National University of Singapore, College Rd, Singapore, 169857, Singapore.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- The Palliative Care Centre for Excellence in Research and Education, PalC, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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8
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Roach P, Hernandez S, Carbert A, Jalil R, Panaccione R, Ruzycki SM. Anti-Indigenous bias of medical school applicants: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:683. [PMID: 36123670 PMCID: PMC9484063 DOI: 10.1186/s12909-022-03739-3] [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: 02/16/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Structural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias. METHODS All applicants to a single university in the 2020-2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating 'cold/unfavourable' to 100, indicating 'warm/favourable') and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students. RESULTS There were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80-100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37-55), and had mild implicit preference for European faces (- 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful. CONCLUSIONS Medical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school.
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Affiliation(s)
- Pamela Roach
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Amanda Carbert
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rabiya Jalil
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Remo Panaccione
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon M Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- , Calgary, Canada.
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9
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de Barros AC, Sadika B, Croteau TA, Morrison MA, Morrison TG. Associations between subcategories of disgust sensitivity and homonegativity: examining intergroup contact as a moderator. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2022.2090270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Bidushy Sadika
- Psychology Department, Western University, London, Ontario, Canada
| | - Terri A. Croteau
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melanie A. Morrison
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Todd G. Morrison
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Westafer LM, Freiermuth CE, Lall MD, Muder SJ, Ragone EL, Jarman AF. Experiences of Transgender and Gender Expansive Physicians. JAMA Netw Open 2022; 5:e2219791. [PMID: 35767255 PMCID: PMC9244607 DOI: 10.1001/jamanetworkopen.2022.19791] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Although LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority) physicians experience bias in the workplace, there is a paucity of data on the experiences of physicians who identify specifically as transgender and/or gender expansive (TGE; gender expansive is an umbrella term encompassing individuals and gender identities that may exist beyond the binary framework [eg, may include nonbinary, genderqueer, and agender individuals]). Objectives To explore the professional experiences of TGE physicians, identify barriers to inclusion, and highlight stakeholder-derived strategies that promote an inclusive workplace. Design, Setting, and Participants This qualitative study informed by semistructured interviews was conducted among 24 TGE physicians in the US from April 1 to December 31, 2021. The sample of TGE physicians was recruited using convenience and snowball sampling. Interviews were recorded and transcribed. Using thematic analysis, at least 2 members of the research team performed blinded coding of each transcript, in an iterative process. Main Outcomes and Measures Data collection and thematic analysis examining themes of physicians' experiences. Results Among 24 physicians (mean [SD] age, 39 [1.4] years) interviewed, 8 (33%) self-identified as transgender women, 7 (29%) as transgender men, 4 (17%) as nonbinary, 3 (13%) as transgender and nonbinary, and 2 (8%) as genderqueer. Prominent themes of the interviews included emotional distress as a result of transphobia, dominance of a rigid binary gender paradigm, and structural and institutional factors that are associated with psychological and physical safety and feelings of isolation as a TGE physician. Clear steps of affirmation were identified that could mitigate the emotional stressors, including signs of safety, active allyship, and mentorship by other TGE physicians. Conclusions and Relevance In this qualitative study, TGE physicians reported facing both overt and subtle biases associated with their identity and gender presentation. Participants also noted several interpersonal and structural factors that mitigate the effect of these biases.
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Affiliation(s)
- Lauren M. Westafer
- Department for Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School–Baystate, Springfield
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michelle D. Lall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah J. Muder
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Eleanor L. Ragone
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Angela F. Jarman
- Department of Emergency Medicine, University of California, Davis, Sacramento
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11
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Meadows A, Barreto M, Dovidio JF, Burke SE, Wittlin NM, Herrin J, Ryn M, Phelan SM. Signaling hostility: The relationship between witnessing weight‐based discrimination in medical school and medical student well‐being. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1111/jasp.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Angela Meadows
- School of Psychology University of Exeter Exeter UK
- Department of Psychology Western University London Ontario Canada
| | | | - John F. Dovidio
- Department of Psychology Yale University New Haven Connecticut USA
| | - Sara E. Burke
- Department of Psychology Syracuse University Syracuse New York USA
| | | | - Jeph Herrin
- School of Medicine Yale University New Haven Connecticut USA
| | - Michelle Ryn
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
| | - Sean M. Phelan
- Division of Health Care Delivery Research Mayo Clinic Rochester Minnesota USA
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12
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Demographic Differences in Medical Students' Perceptions of Respect for Diversity Among Faculty. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S218-S219. [PMID: 34705721 DOI: 10.1097/acm.0000000000004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jasmine Weiss
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Lilanthi Balasuriya
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Laura D Cramer
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Marcella Nunez-Smith
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Inginia Genao
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Rosana Gonzalez-Colaso
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Ambrose H Wong
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | | | - Darin Latimore
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Dowin Boatright
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Mona Sharifi
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
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Cruz TM, Paine EA. Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts. Soc Sci Med 2021; 285:114295. [PMID: 34428618 PMCID: PMC8765327 DOI: 10.1016/j.socscimed.2021.114295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/30/2022]
Abstract
In effort to address fundamental causes and reduce health disparities, public programs increasingly mandate sites of care to capture patient data on social and behavioral domains within Electronic Health Records (EHRs). Data reporting drawing from EHRs plays an essential role in public management of social problems, and data on social factors are commonly cited as foundational for eliminating health inequities. Yet one major shortcoming of these data-centered initiatives is their limited attention to social context, including the institutional conditions of biomedical stratification and variation of care provision across clinical settings. In this article, we leverage comparative fieldwork to examine provider and system responses to mandated data collection on patient sexual orientation and gender identity (SOGI), highlighting unequal clinical contexts as they appear across a large county safety-net institution and an LGBTQ-oriented health organization. Although point of care data collection is commonly justified for governance in the aggregate (e.g., disparity monitoring), we find standardized data on social domains presents a double-edged sword in clinical settings: formal categories promote visibility where certain issues remain hidden, yet constrain clinical utility in sites with greater knowledge and experience with related topics. We further illustrate how data standardization captures patient identities yet fundamentally misses these unequal contexts, resulting in limited attenuation of inequity despite broad expectations of clinical change. By revealing the often-invisible contexts of care that elude standard measurement, our findings underline the strengths of qualitative social science in accounting for the complex dynamics of enduring social problems. We call for deeper engagement with the unequal contexts of biomedical stratification, especially in light of increasing pressure to quantify the social amidst the rising tide of data-driven care.
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Affiliation(s)
- Taylor M Cruz
- California State University, Fullerton, Department of Sociology, 2600 Nutwood Avenue, College Park 900, Fullerton, CA 92831, United States.
| | - Emily Allen Paine
- Columbia University and New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, 722 W 168th Street, New York, NY 10032, United States.
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14
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Brown JR, Enos RD, Feigenbaum J, Mazumder S. Childhood cross-ethnic exposure predicts political behavior seven decades later: Evidence from linked administrative data. SCIENCE ADVANCES 2021; 7:7/24/eabe8432. [PMID: 34117056 PMCID: PMC8195477 DOI: 10.1126/sciadv.abe8432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/26/2021] [Indexed: 06/01/2023]
Abstract
Does contact across social groups influence sociopolitical behavior? This question is among the most studied in the social sciences with deep implications for the harmony of diverse societies. Yet, despite a voluminous body of scholarship, evidence around this question is limited to cross-sectional surveys that only measure short-term consequences of contact or to panel surveys with small samples covering short time periods. Using advances in machine learning that enable large-scale linkages across datasets, we examine the long-term determinants of sociopolitical behavior through an unprecedented individual-level analysis linking contemporary political records to the 1940 U.S. Census. These linked data allow us to measure the exact residential context of nearly every person in the United States in 1940 and, for men, connect this with the political behavior of those still alive over 70 years later. We find that, among white Americans, early-life exposure to black neighbors predicts Democratic partisanship over 70 years later.
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Affiliation(s)
- Jacob R Brown
- Institute for Quantitative Social Science and Department of Government, Harvard University, 1737 Cambridge Street, Cambridge, MA 02138, USA
| | - Ryan D Enos
- Institute for Quantitative Social Science and Department of Government, Harvard University, 1737 Cambridge Street, Cambridge, MA 02138, USA.
| | - James Feigenbaum
- Department of Economics, Boston University, 270 Bay State Road, Boston, MA 02215, USA
| | - Soumyajit Mazumder
- Institute for Quantitative Social Science and Department of Government, Harvard University, 1737 Cambridge Street, Cambridge, MA 02138, USA
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15
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity. JAMA Netw Open 2021; 4:e2112795. [PMID: 34086032 PMCID: PMC8178710 DOI: 10.1001/jamanetworkopen.2021.12795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. OBJECTIVE To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. RESULTS Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). CONCLUSIONS AND RELEVANCE In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
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Affiliation(s)
- Jasmine Weiss
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Laura D. Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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16
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Soffer M, Cohen M, Azaiza F. The Moderating Role of Clinical Experience in the Relationship Between Patient Characteristics, Attributed Barriers to Mammography, Beliefs About Cancer, and Clinical Decisions: a Study of Israeli Arab Physicians. J Racial Ethn Health Disparities 2021; 9:731-737. [PMID: 33666896 DOI: 10.1007/s40615-021-01008-5] [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: 09/14/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
This study examined whether clinical experience moderates the relationship between three potential physician biases (patient characteristics; cancer-related beliefs, i.e., traditional and fatalistic beliefs; and attributed barriers to mammogram performance) and clinical decisions (recommending and discussing mammography with Arab women patients). A survey was conducted among 146 randomly sampled (cluster sampling) Arab physicians who serve the Arab population in Israel. We found that the least experienced physicians recommended and discussed mammography to a lesser extent than experienced doctors. Less experienced physicians were also less inclined to discuss and recommend mammography to women with specific characteristics (religious women, women with lower education levels, and women who expressed high fatalistic beliefs) and held significantly higher traditional beliefs concerning cancer. The correlation between patient characteristics and clinical decision making was both direct and moderated by clinical experience (stronger for the least experienced and moderately experienced physicians). Cancer-related beliefs had a direct negative effect on recommending and discussing mammography. The findings suggest that greater clinical experience with Arab women patients might reduce physician bias pertaining to patient characteristics among less experienced doctors who serve patients of the same ethnicity. Nonetheless, the findings imply that anti-stigma interventions should not rely on prolonged contact and should be implemented among all physicians, regardless of their clinical experience.
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Affiliation(s)
- Michal Soffer
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.
| | - Miri Cohen
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
| | - Faisal Azaiza
- School of Social Work, Faculty of Social Welfare & Health Sciences, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
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17
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Reuben JS, Crawley WT, Webb P, den Brok KF, Woodburn E, Montemayor JR, Roberts-Lieb S, de Jong PGM, Dickinson BL. IAMSE Meeting Report: Student Plenary at the 24th Annual Conference of the International Association of Medical Science Educators. MEDICAL SCIENCE EDUCATOR 2020; 30:13-15. [PMID: 33014622 PMCID: PMC7518944 DOI: 10.1007/s40670-020-01087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Paris Webb
- Texas A&M University College of Dentistry, Dallas, TX USA
| | | | | | | | | | - Peter G. M. de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
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18
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Nowaskie D. A national survey of U.S. psychiatry residents’ LGBT cultural competency: The importance of LGBT patient exposure and formal education. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2020.1774848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Dustin Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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19
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Wang K, Burke SE, Przedworski JM, Wittlin NM, Onyeador IN, Dovidio JF, Dyrbye LN, Herrin J, van Ryn M. A Comparison of Depression and Anxiety Symptoms Between Sexual Minority and Heterosexual Medical Residents: A Report from the Medical Trainee CHANGE Study. LGBT Health 2020; 7:332-339. [PMID: 32598215 DOI: 10.1089/lgbt.2020.0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: The pervasiveness of sexual minority stressors in the U.S. medical training environment is well documented, yet little is known about the mental health impact of such stressors on sexual minority medical residents. We compared depression and anxiety symptoms between sexual minority and heterosexual third-year medical residents, adjusting for depression and anxiety before residency, and examined the role of perceived residency belonging during the second year of residency as a predictor of subsequent sexual identity-based differences in depression and anxiety. Methods: In 2010-2011, first-year medical students enrolled in the Cognitive Habits and Growth Evaluation Study and completed surveys in the last year of medical school (MS4; 2014), as well as second (R2; 2016) and third (R3; 2017) year of residency. The surveys contained measures of sexual identity, residency belonging, depression, and anxiety. Results: Of the 2890 residents who provided information about their sexual identity, 291 (10.07%) identified as sexual minority individuals. Sexual minority residents reported significantly higher levels of depression (p = 0.009) and anxiety (p = 0.021) than their heterosexual peers at R3, even after adjusting for depression and anxiety at MS4. Sexual minority residents also reported a lower sense of belonging at R2 than did heterosexual residents (p = 0.006), which was in turn associated with higher levels of depression and anxiety at R3 (ps < 0.001). Conclusion: Sexual minority residents experienced higher levels of depression and anxiety than their heterosexual counterparts, and these mental health disparities were associated with lower perceived belonging in residency. Residency programs should prioritize evidence-based, targeted interventions for sexual minority mental health.
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Affiliation(s)
- Katie Wang
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sara E Burke
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Julia M Przedworski
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Natalie M Wittlin
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Ivuoma N Onyeador
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Liselotte N Dyrbye
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeph Herrin
- Division of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
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20
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Hill KA, Samuels EA, Gross CP, Desai MM, Sitkin Zelin N, Latimore D, Huot SJ, Cramer LD, Wong AH, Boatright D. Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation. JAMA Intern Med 2020; 180:653-665. [PMID: 32091540 PMCID: PMC7042809 DOI: 10.1001/jamainternmed.2020.0030] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation. OBJECTIVE To examine the association between mistreatment and medical student sex, race/ethnicity, and sexual orientation. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The questionnaire annually surveys graduating students at all 140 accredited allopathic US medical schools. Participants were graduates from allopathic US medical schools in 2016 and 2017. Data were analyzed between April 1 and December 31, 2019. MAIN OUTCOMES AND MEASURES Prevalence of self-reported medical student mistreatment by sex, race/ethnicity, and sexual orientation. RESULTS A total of 27 504 unique student surveys were analyzed, representing 72.1% of graduating US medical students in 2016 and 2017. The sample included the following: 13 351 female respondents (48.5%), 16 521 white (60.1%), 5641 Asian (20.5%), 2433 underrepresented minority (URM) (8.8%), and 2376 multiracial respondents (8.6%); and 25 763 heterosexual (93.7%) and 1463 lesbian, gay, or bisexual (LGB) respondents (5.3%). At least 1 episode of mistreatment was reported by a greater proportion of female students compared with male students (40.9% vs 25.2%, P < .001); Asian, URM, and multiracial students compared with white students (31.9%, 38.0%, 32.9%, and 24.0%, respectively; P < .001); and LGB students compared with heterosexual students (43.5% vs 23.6%, P < .001). A higher percentage of female students compared with male students reported discrimination based on gender (28.2% vs 9.4%, P < .001); a greater proportion of Asian, URM, and multiracial students compared with white students reported discrimination based on race/ethnicity (15.7%, 23.3%, 11.8%, and 3.8%, respectively; P < .001), and LGB students reported a higher prevalence of discrimination based on sexual orientation than heterosexual students (23.1% vs 1.0%, P < .001). Moreover, higher proportions of female (17.8% vs 7.0%), URM, Asian, and multiracial (4.9% white, 10.7% Asian, 16.3% URM, and 11.3% multiracial), and LGB (16.4% vs 3.6%) students reported 2 or more types of mistreatment compared with their male, white, and heterosexual counterparts (P < .001). CONCLUSIONS AND RELEVANCE Female, URM, Asian, multiracial, and LGB students seem to bear a disproportionate burden of the mistreatment reported in medical schools. It appears that addressing the disparate mistreatment reported will be an important step to promote diversity, equity, and inclusion in medical education.
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Affiliation(s)
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cary P Gross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Nicole Sitkin Zelin
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, California
| | - Darin Latimore
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Stephen J Huot
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Laura D Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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21
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Filling the void in lesbian, gay, bisexual, transgender and queer (LGBTQ+) leadership training. Leadersh Health Serv (Bradf Engl) 2020. [DOI: 10.1108/lhs-09-2019-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Leadership training refers to the process of helping individuals develop skills to successfully perform in leadership positions. Existing leadership programs have several drawbacks, including the paucity of leadership programs designed for lesbian, gay, bisexual, transgender and queer (LGBTQ+) individuals in health care. The authors addressed this gap by creating and hosting Q-Forward (formerly Q-Med), the first conference focused specifically on leadership development for LGBTQ+ health trainees.
Design/methodology/approach
In this paper, the authors explain how a conference focused on leadership development for LGBTQ+ health trainees can have benefits for trainees, patients and the health-care system. The authors also report the conference proceedings, including planning, participants, guiding principles and programming.
Originality/value
This conference was the first conference for LGBTQ+ health trainees focused specifically on leadership training. The authors believe that the conference was unique, and that such training represents an essential step toward long-term improvements in the health of LGBTQ+ people and other populations.
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