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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Mohamed Shaburdin Z, Bourke L, Mitchell O, Newman T. 'It's a cultural thing': excuses used by health professionals on providing inclusive care. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:1-15. [PMID: 34018893 DOI: 10.1080/14461242.2020.1846581] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.
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Affiliation(s)
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
| | - Olivia Mitchell
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
| | - Trudie Newman
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
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Chisholm LP, Jackson KR, Davidson HA, Churchwell AL, Fleming AE, Drolet BC. Evaluation of Racial Microaggressions Experienced During Medical School Training and the Effect on Medical Student Education and Burnout: A Validation Study. J Natl Med Assoc 2020; 113:310-314. [PMID: 33358632 DOI: 10.1016/j.jnma.2020.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/12/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Microaggressions in the learning environment have been documented at various levels of medical training. However, there is lack of data detailing the prevalence and effects of racial microaggressions in medical school. This limits interventions that might improve the learning environment for underrepresented minority medical students (URMMS). This study describes the creation and validation of a survey instrument characterizing the experience of microaggressions in medical school and their impact on medical student education and burnout. METHODS An anonymous survey instrument was adapted for medical students from the validated Racial and Ethnic Microaggressions Scale (REMS) and distributed to the national listservs of the Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), and the Asian Pacific American Medical Student Association. Responses were categorized into two cohorts: under-represented minority (URM) and non-URM based on self-reported race or ethnicity. RESULTS A total of 217 responses were collected from medical students across the United States, with 148 (68.2%) students identifying as URM. URM respondents were significantly (p < 0.05) more likely to report experiencing race-related microaggressions during medical school (55% vs 31%), and to report that these microaggressions contributed to feelings of burnout (62% vs 29%) and compromised learning (64% vs 49%). URM students were significantly less likely to feel that adequate resources were available to address microaggressions (26% vs 39%, p < 0.05). CONCLUSIONS Our results suggest that microaggressions experienced by URMMS can be evaluated using an adapted REMS. Additionally, the experience of microaggressions negatively impact the learning environment, and students feel the availability of sufficient resources to address microaggressions and their effects are lacking. Further research is needed to evaluate microaggressions and their impact on a larger scale. This should be followed by interventions to minimize the frequency and impact of these microaggressions.
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Affiliation(s)
- Leah P Chisholm
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kianna R Jackson
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Amy E Fleming
- Vanderbilt University Medical School of Medicine, Nashville, TN, USA
| | - Brian C Drolet
- Department of Plastic Surgery, Biomedical Informatics and Center for Biomedical Ethics and Society; Vanderbilt University Medical Center, Nashville, TN, USA.
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Lu DW, Pierce A, Jauregui J, Heron S, Lall MD, Mitzman J, McCarthy DM, Hartman ND, Strout TD. Academic Emergency Medicine Faculty Experiences with Racial and Sexual Orientation Discrimination. West J Emerg Med 2020; 21:1160-1169. [PMID: 32970570 PMCID: PMC7514380 DOI: 10.5811/westjem.2020.6.47123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Despite the increasing diversity of individuals entering medicine, physicians from racial and sexual minority groups continue to experience bias and discrimination in the workplace. The objective of this study was to determine the current experiences and perceptions of discrimination on the basis of race and sexual orientation among academic emergency medicine (EM) faculty. METHODS We conducted a cross-sectional survey of a convenience sample of EM faculty across six programs. Survey items included the Overt Gender Discrimination at Work (OGDW) Scale adapted for race and sexual orientation, and the frequency and source of experienced and observed discrimination. Group comparisons were made using t-tests or chi-square analyses, and relationships between race or sexual orientation, and we evaluated physicians' experiences using correlation analyses. RESULTS A total of 141 out of 352 (40.1%) subjects completed at least a portion of the survey. Non-White physicians reported higher mean racial OGDW scores than their White counterparts (13.4 vs 8.6; 95% confidence interval (CI) for difference, -7.7 - -2.9). Non-White EM faculty were also more likely to report having experienced discriminatory treatment based on race than were White EM faculty (48.0% vs 12.6%; CI for difference, 16.6% - 54.2%), although both groups were equally likely to report having observed race-based discrimination of another physician. EM faculty who identified as sexual minorities reported higher mean sexual minority OGDW scores than their heterosexual counterparts (11.1 vs 7.1; 95% CI for difference, -7.3 - -0.6). There were no significant differences between sexual minority and heterosexual faculty in their reports of experiencing or observing discrimination based on sexual orientation. CONCLUSION EM faculty from racial and sexual minority groups perceived more discrimination based on race or sexual orientation in their workplace than their majority counterparts. EM faculty regardless of race or sexual orientation were similar in their observations of discriminatory treatment of another physician based on race or sexual orientation.
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Affiliation(s)
- Dave W Lu
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Ava Pierce
- University of Texas Southwestern Medical School, Department of Emergency Medicine, Dallas, Texas
| | - Joshua Jauregui
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Sheryl Heron
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Michelle D Lall
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | - Jennifer Mitzman
- The Ohio State University College of Medicine, Department of Emergency Medicine, Columbus, Ohio
| | - Danielle M McCarthy
- Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
| | - Nicholas D Hartman
- Wake Forest School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Tania D Strout
- Tufts University School of Medicine - Maine Medical Center, Department of Emergency Medicine, Portland, Maine
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Krupat E, Camargo CA, Espinola JA, Fleenor TJ, Strewler GJ, Dienstag JL. A snapshot of underrepresented physicians 15 years after medical school. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:711-730. [PMID: 31982974 DOI: 10.1007/s10459-020-09954-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
We conducted a study to compare medical school experiences, values, career paths, and career satisfaction of under-represented in medicine (URiM) and non-URiM physicians approximately 15 years after medical school, guided by the Theory of Planned Behavior and the concept of stereotype threat. The sample consisted of four graduating classes, 1996-1999, of Harvard Medical School, 20% of whom were URiM. URiM respondents came from families of lower educational attainment and graduated with more debt. As students, they reported a greater experience of stereotype threat and, and at graduation they showed a tendency to place a higher value on avoiding a career that places them under constant pressure. Concerning their current status, URiM respondents expressed a lower level of satisfaction with their career progress. Multivariable analyses indicated that across the entire sample, URiM status was not a significant predictor of employment in academic medicine, but that being in academic medicine was predicted by mentors' encouragement for a research career, greater intention to pursue research, and a lower value on having a financially rewarding career. Lower career satisfaction was predicted by one's status as URiM, employment in academic medicine, greater involvement in research, and a greater value on avoiding constant pressure. The data suggest that negative student experiences in medical school, combined with the lack of mentor encouragement and financial pressures may discourage URiM medical students from pursuing academic careers, and that pressures for productivity and working in academic medicine may degrade the satisfaction derived by physicians in general.
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Affiliation(s)
- Edward Krupat
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Janice A Espinola
- Harvard Medical School, Boston, MA, USA
- EMNet Coordinating Center, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J Fleenor
- Office of Educational Quality Improvement, Harvard Medical School, Boston, MA, USA
| | - Gordon J Strewler
- Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Jules L Dienstag
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Kanter JW, Rosen DC, Manbeck KE, Branstetter HML, Kuczynski AM, Corey MD, Maitland DWM, Williams MT. Addressing microaggressions in racially charged patient-provider interactions: a pilot randomized trial. BMC MEDICAL EDUCATION 2020; 20:88. [PMID: 32209082 PMCID: PMC7092438 DOI: 10.1186/s12909-020-02004-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/13/2020] [Indexed: 05/22/2023]
Abstract
BACKGROUND Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Innovations in training interventions are needed to decrease microaggressions and improve provider communication and rapport with patients of color during medical encounters. METHODS This paper presents a pilot randomized trial of an innovative clinical workshop that employed a theoretical model from social and contextual behavioral sciences. The intervention specifically aimed to decrease providers' likelihood of expressing biases and negative stereotypes when interacting with patients of color in racially charged moments, such as when patients discuss past incidents of discrimination. Workshop exercises were informed by research on the importance of mindfulness and interracial contact involving reciprocal exchanges of vulnerability and responsiveness. Twenty-five medical student and recent graduate participants were randomized to a workshop intervention or no intervention. Outcomes were measured via provider self-report and observed changes in targeted provider behaviors. Specifically, two independent, blind teams of coders assessed provider emotional rapport and responsiveness during simulated interracial patient encounters with standardized Black patients who presented specific racial challenges to participants. RESULTS Greater improvements in observed emotional rapport and responsiveness (indexing fewer microaggressions), improved self-reported explicit attitudes toward minoritized groups, and improved self-reported working alliance and closeness with the Black standardized patients were observed and reported by intervention participants. CONCLUSIONS Medical providers may be more likely to exhibit bias with patients of color in specific racially charged moments during medical encounters. This small-sample pilot study suggests that interventions that directly intervene to help providers improve responding in these moments by incorporating mindfulness and interracial contact may be beneficial in reducing racial health disparities.
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Morsy L. Toxic stress and clinical teaching. CLINICAL TEACHER 2019; 17:452-454. [PMID: 31773864 DOI: 10.1111/tct.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leila Morsy
- Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Snyder CR, Wang PZ, Truitt AR. Multiracial Patient Experiences With Racial Microaggressions in Health Care Settings. J Patient Cent Res Rev 2018; 5:229-238. [PMID: 31414007 PMCID: PMC6664327 DOI: 10.17294/2330-0698.1626] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Illuminating patients' experiences of microaggressions in health care settings can help practitioners develop care that is more culturally responsive. While much of the literature on health care disparities focuses on minority groups generally, we sought to identify and to describe the ways in which racial microaggressions manifest for multiracial individuals and families specifically. METHODS Using a combination of interviews and focus groups, we conducted 15 interviews and 3 focus groups. Eligible participants self-identified as more than one race and/or they self-identified as part of an interracial family, and they and/or someone they considered to be part of their family received health care in the past 12 months. We performed a content analysis to describe the dominant ways racial microaggressions presented in health care interactions. RESULTS A total of 31 participants shared their experiences in health care settings, including their experiences with racism, racial bias, and microaggressions. Based on their experiences, we describe 6 prevalent microaggressions: mistaken identity, mistaken relationships, fixed forms, entitled examiner, pervasive stereotypes, and intersectionality. Many acknowledged their experiences with racial microaggressions in health care were similar to those they experienced in everyday settings; however, the power dynamics differed in health care. CONCLUSIONS Understanding patient perspectives about racial microaggressions suggests opportunities to improve patient-provider communication. For multiracial individuals and families, racial microaggressions may have implications for patient engagement in health care. Findings of this study highlight implications for theory and research as well as opportunities to facilitate systematic improvements in the provision of culturally responsive health care services.
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Affiliation(s)
- Cyndy R. Snyder
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Prince Z. Wang
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
| | - Anjali R. Truitt
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
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