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Kerins J, Phillips EC, Smith SE, Tallentire VR. The Rubik's cube of doing and being: Factors influencing professional identity transition to the medical registrar. CLINICAL TEACHER 2024; 21:e13713. [PMID: 38069581 DOI: 10.1111/tct.13713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/07/2023] [Indexed: 09/03/2024]
Abstract
BACKGROUND Professional identity transitions, such as the transition to medical registrar, are challenging. How minoritised identities influence transitions during medical training requires further study. This study aimed to explore the factors influencing the transition to the medical registrar in Scotland to guide support during training. METHODS Interviews exploring this transition with internal medicine trainees were audio recorded, transcribed verbatim and double-coded using template analysis. We applied an initial coding template informed by multiple and multidimensional transition theory of individual, interpersonal, systemic and macro-level factors. Using a critical theory lens, a further template analysis specifically sought to understand how trainees' social identities interacted with the various levels. FINDINGS Nineteen IM trainees were interviewed between January 2021 and February 2022. Influential factors reflected a parallel process of competence (doing) and identity (being) development. The interaction of social identities, such as gender (being a woman) and country of origin (being an international medical graduate), occurred across levels. This can be conceptualised as a Rubik's cube with the interplay between doing and being from an individual to a macro level with trainees' social identities interacting at all levels. CONCLUSION The transition to the medical registrar is multifaceted; with a challenging balance between support and independence in providing opportunities to perform (doing) whilst identity develops (being). Identity transitions involve multiple Rubik's-cube-like rotations between the facets of 'doing' and 'being,' until these align. Taking heed of influential factors and the interaction of minoritised social identities could guide a trainee-centred and smoother transition.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Samantha E Smith
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Lothian, Edinburgh, UK
| | - Victoria R Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Lothian, Edinburgh, UK
- NHS Education for Scotland, Edinburgh
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Blalock AE, Ozdemir S, Garcia AJ, Lyons EG. "The faculty was really hearing what I had to say and really validating who I was": Learning from validation theory to support students of colour in undergraduate medical education. MEDICAL EDUCATION 2024; 58:1117-1125. [PMID: 38376060 DOI: 10.1111/medu.15364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Medical students of colour face numerous challenges during their undergraduate training period, reflecting the harmful norms and cultures in the learning context of medical school. Despite negative experiences for students of colour in medicine, there are episodes of support and encouragement that come from faculty or staff. This asset-based qualitative study uses Rendón's Validation Theory to illuminate specific ways faculty at a community-based medical college support medical students of colour, thereby challenging structural injustices in medical school. METHODS This study is grounded in a humanising and asset-based perspective, where participants are viewed as legitimate knowers from whom researchers can learn. Twenty-four medical students of colour and 14 faculty identified by students as supportive participated in five focus groups where participants shared how they felt validated and supported during their undergraduate medical school experiences. Inductive open-coding followed by deductive thematic coding using Validation Theory-a theory that describes how external validation is a necessary component of fostering students' personal and academic drive-and literature about the context of medical school informed the three findings. FINDINGS Three major themes provide examples of ways faculty validated students. First, participants indicated the importance of acknowledging identities and experiences to understand the socio, historical and cultural context of learning. Second, participants implored the value of giving praise and offering encouragement to work against professional expectations. Finally, participants shared the intimacy of fostering personal relationships to reduce hierarchies. CONCLUSION This study offers concrete guidance on teaching practices faculty can use to support students of colour. As medical schools may seek to move toward a more student-centred approach, promoting feelings of validation for students of colour can be a key practice in teaching and learning to ensure support for medical students throughout their medical school journey.
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Affiliation(s)
- A Emiko Blalock
- Department of Family Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Sevil Ozdemir
- Michigan State University, East Lansing, Michigan, USA
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Ly D, Chakrabarti R. ' I'm looking as white and as straight as possible at all times': a qualitative study exploring the intersectional experiences of BAME LGBTQ+ medical students in the UK. BMJ Open 2024; 14:e086346. [PMID: 39160106 PMCID: PMC11337697 DOI: 10.1136/bmjopen-2024-086346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/02/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES The positive formation of professional identity is considered crucial in how medical students begin to feel and act as clinicians. Although, awareness of how Professional Identity Formation (PIF) may be affected among minoritised groups is increasing, understanding from an intersectional lens remains limited. The aim of this study was to explore the experiences of Black, Asian, Minoritised Ethnic (BAME) and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) medical students in the undergraduate Bachelor of Medicine, Bachelor of Science programme. DESIGN Based on the methodology of phenomenography, all medical students identifying as BAME and LGBTQ+ were eligible for participation. Semistructured interviews were conducted with data collection continuing until theoretical saturation was reached. The coding framework was developed independently by the principal researcher and supervisor before being compared to create a shared analytical framework. SETTING University College London Medical School (UCLMS) between October 2022 and February 2023. PARTICIPANTS Six UCLMS students were recruited, one of whom was in the 'early' years (years 1-3) with the remainder in the 'later' years (years 4-6) RESULTS: Six main themes emerged from the data, which were categorised into three main areas: challenges to intersectionality, benefits to intersectionality and protective factors. Challenges to intersectionality included three themes, 'The BAME identity interacting with the LGBTQ+identity', 'BAME background influencing LGBTQ+identity exploration' and 'no true safe spaces for BAME and LGBTQ+ students to be themselves'. Benefits to intersectionality included 'greater insight into the self' and protective factors included two themes of 'peer support networks' and 'visibility within the university and clinical environments.' CONCLUSION By exploring PIF among medical students from an intersectional lens, this study highlights the increased emotional burden faced by those who identify as BAME and LGBTQ+, as they attempt to reconcile both these identities with becoming a future doctor, affecting their sense of belonging socially and within the profession. Despite being based at a single medical school, it highlights the importance of creating a truly inclusive environment through positive role modelling and increased visibility among the BAME, LGBTQ+ community in the undergraduate programme.
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Affiliation(s)
- Daniel Ly
- University College London Medical School, London, UK
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Yemane L, Powell C, Edwards J, Shumba T, Alvarez A, Bandstra B, Brooks M, Brown-Johnson C, Caceres W, Dunn T, Johnson C, Perez FD, Reece-Nguyen T, Thomas RP, Watkins AC, Blankenburg R. Underrepresented in Medicine Trainees' Sense of Belonging and Professional Identity Formation after Participation in the Leadership Education in Advancing Diversity Program. Acad Pediatr 2024:S1876-2859(24)00321-8. [PMID: 39117029 DOI: 10.1016/j.acap.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/10/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI. OBJECTIVE Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles. METHODS IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory. RESULTS 14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles. CONCLUSIONS LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.
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Affiliation(s)
- Lahia Yemane
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
| | - Carmin Powell
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Edwards
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Takudzwa Shumba
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Belinda Bandstra
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, Sacramento, California
| | - Michelle Brooks
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, California
| | - Cati Brown-Johnson
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Wendy Caceres
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Tamara Dunn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Carrie Johnson
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, California
| | - Felipe D Perez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Travis Reece-Nguyen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Reena P Thomas
- Department of Neurology, Stanford University School of Medicine, Palo Alto, California
| | - Amelia C Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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El-Desoky R, Diec S, Truong M, Rosario N. Who am I? Professional Identity Formation in Pharmacy Education Among Learners Underrepresented in Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100748. [PMID: 38944278 DOI: 10.1016/j.ajpe.2024.100748] [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: 08/04/2022] [Revised: 07/10/2023] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
Professional identity formation (PIF) throughout the pharmacy curriculum is important for learners to transform from layperson to pharmacist. To be effective, PIF activities need intentional development and support. Professional identity is often seen as the core component of PIF; however, there must be an emphasis on integrating and aligning an individual's personal identity through this process. Moreover, there has been an emphasis on upholding diversity, equity, inclusion, and antiracism efforts in pharmacy practice and education. There is a need to explore experiences of PIF among diverse populations, including learners underrepresented in pharmacy. This commentary explores the differences in PIF among underrepresented learners in health care disciplines and is a call to action to explore evidence-based interventions that are inclusive and tailored to individual learners. This commentary sets a foundation for additional scholarly work and recommendations regarding PIF among underrepresented learners.
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Affiliation(s)
- Rania El-Desoky
- University of Western Australia, Crawley, Western Australia, Australia.
| | - Sandy Diec
- University of Houston College of Pharmacy, Houston, TX, USA
| | - Mabel Truong
- University of Houston College of Pharmacy, Houston, TX, USA
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Miyachi J, Iwakuma M, Nishigori H. An "integration" of professional identity formation among rural physicians experiencing an interplay between their professional and personal identities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10337-z. [PMID: 38740649 DOI: 10.1007/s10459-024-10337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
The present understanding of professional identity formation is problematic since it underrepresents minority physicians and potentially excludes their professional identity formation experiences. Rural physicians are expected to have similar underrepresented aspects as minority physicians because of their specific sociocultural contexts and consequent private-professional intersection, which lead to ethical complexities. Therefore, to bridge this research gap, we interviewed 12 early- to mid-career Japanese physicians working in rural areas and explored their experiences. Through a narrative analysis guided by Figured Worlds theory, we analysed the data by focusing on the vocabulary, expressions, and metaphors participants used to describe their experiences. A central theme emerged concerning how the rural physicians configurated their personal versus professional participation in their local communities. Further, their identity narratives varied regarding how they constructed their identities, rural communities, and relationships as well as their identity formation ideals and strategies to achieve them. Informed by 'Big Questions' concerning worldview framework, we delineated four identity narratives as prototypes to describe how they participated in their communities. These identity narratives provide a preliminary understanding of how diverse identity formation is for rural physicians. In addition, our findings exposed the current professional identity formation framework as potentially biased towards single forms of participation in monolithic communities, overlooking complicated forms of participation in multiple communities. We argue that applying frameworks and concepts to capture these multiple forms of participation as well as revisiting the 'discourse of integration' are necessary steps to overcome the limitation of the current understanding of professional identity formation.
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Affiliation(s)
- Junichiro Miyachi
- Center for Medical Education, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8560, Japan.
- Academic and Research Centre, The Hokkaido Centre for Family Medicine, Hokkaido, Japan.
| | - Miho Iwakuma
- Department of Medical Communication, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Nishigori
- Center for Medical Education, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho Showa-ku Nagoya, Aichi, 466-8560, Japan
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Konopasky A, Ma TL, Wyatt TR. Pushing, standing and bringing to light: How medical trainees conceptualise professional resistance. MEDICAL EDUCATION 2024. [PMID: 38702993 DOI: 10.1111/medu.15400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Much of the literature on harm and injustice in medical education focuses on the impact of oppression rather than trainees' efforts to create change. To acknowledge and make visible these efforts, medical education professionals must grasp how trainees perceive resistance and their role in effecting change. Employing functional linguistic and 'everyday' resistance theories, this critical qualitative study aims to understand trainees' conceptions of resistance practices and their representational choices in moments when they talked about and conceptualised resistance. METHODS Gathering participants through professional networks and snowball sampling, this study employed in-depth interviews to explore the conceptualisations of resistance among North American medical trainees (9 medical students, 9 residents and fellows). With the use of an applied functional linguistic analysis framework, we analysed the representational metafunction in trainees' conceptualisation of their resistance efforts against social injustice. We began with open coding for 'everyday' acts of resistance and then shifted to focused coding on verbal process types in participants' language to characterise their conceptualisations of resistance. FINDINGS Participants conceptualised their resistance practices in three distinct ways: first, an almost physical pushing back, drawing largely on material process types (doing); second, an embodied standing up and being present, based predominantly on material and relational process types (being); and third, an epistemic bringing to light, grounded mostly in mental and verbal process types (thinking). These processes of resistance reflect participants' conceptualisations of their efforts to challenge the status quo around inequity, harm and injustice in medical education. CONCLUSION This study builds on resistance literature, offering a potential typology of resistance practices as pushing back, being and bringing to light. Because these are 'everyday' acts of resistance, these are tactics available to everyone, including faculty; we all have the power to resist, whether it is in teaching and learning or interacting with larger structures in medicine.
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Affiliation(s)
- Abigail Konopasky
- Department of Medical Education, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Ting Lan Ma
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tasha R Wyatt
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Nemiroff S, Blanco I, Burton W, Fishman A, Joo P, Meholli M, Karasz A. Moral injury and the hidden curriculum in medical school: comparing the experiences of students underrepresented in medicine (URMs) and non-URMs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:371-387. [PMID: 37382857 DOI: 10.1007/s10459-023-10259-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
Underrepresented students in medicine (URM) have more negative perceptions of the medical school learning environment (LE), a phenomenon that can contribute to higher rates of burnout and attrition in these populations. The hidden curriculum (HC)-defined as a set of values informally conveyed to learners through clinical role-modeling-is a LE socialization construct that has been critically examined for its role in shaping students' professional identities. Yet differences in how URMs and non-URMs experience the HC remain underexplored. The study used a pragmatic approach that drew on elements of grounded theory and employed both deductive and inductive reasoning. Investigators conducted qualitative, semi-structured interviews with a purposive sample of 13 URM and 21 non-URM participants at a Bronx, NY medical school. Interviews examined student experiences and reactions to the HC. Both cohorts witnessed patient disparagement and mistreatment. However, from these encounters, URM participants expressed more moral injury-the adverse emotional consequence of feeling pressured to accept ideologically incongruent values. URMs were also more likely to describe resisting the HC. Differences in group reactions appeared to arise from URMs' identity resonance with patients' lived experiences. Participants across cohorts emphasized increasing URM recruitment as one step toward mitigating these circumstances. URM participants experienced more distress and offered more resistance to the HC relative to non-URMs. The etiology of these differential reactions may stem from relative barriers in negotiating personal and professional identities. As such, URMs' perceptions of the LE may be adversely impacted given their more negative interactions with the HC.
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Affiliation(s)
- Samuel Nemiroff
- Albert Einstein College of Medicine, New York City, NY, USA.
- Mount Sinai Morningside-West, New York City, USA.
| | - Irene Blanco
- Medicine-Rheumatology, Clinical Research Ethics & Equity Consultative Service (CREEC), Northwestern University, Chicago, IL, USA
| | - William Burton
- Assessment, Evaluation and Quality Improvement in the Office of Medical Education, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ariel Fishman
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pablo Joo
- Department of Family Medicine, University of California, Riverside, CA, USA
| | - Mimoza Meholli
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alison Karasz
- Department of Family Medicine and Community Health, Chan Medical School, University of Massachusetts, Worcester, MA, USA
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Sivananthajothy P, Adel A, Afhami S, Castrogiovanni N, Osei-Tutu K, Brown A. Equity, diversity, and…exclusion? A national mixed methods study of "belonging" in Canadian undergraduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:611-639. [PMID: 37563338 DOI: 10.1007/s10459-023-10265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging.
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Affiliation(s)
| | - Adibba Adel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shima Afhami
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nina Castrogiovanni
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kannin Osei-Tutu
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Allison Brown
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Sarraf-Yazdi S, Pisupati A, Goh CK, Ong YT, Toh YR, Goh SPL, Krishna LKR. A scoping review and theory-informed conceptual model of professional identity formation in medical education. MEDICAL EDUCATION 2024. [PMID: 38597258 DOI: 10.1111/medu.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to 'think, act, and feel like a physician'. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short-sighted or reactionary responses to systemic issues. METHODS A Systematic Evidence-Based Approach-guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases. RESULTS A total of 2441 abstracts were reviewed, 607 full-text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it. CONCLUSIONS Based on regnant theories and frameworks related to self-concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory-backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.
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Affiliation(s)
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - You Ru Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Suzanne Pei Lin Goh
- Duke-NUS Medical School, National University of Singapore, Singapore
- KK Women's and Children Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Duke-NUS Medical School, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, United Kingdom Cancer Research Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore
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Wyatt TR, Jain V, Ma TL. 'When I stood up for something it's because I felt a… moral violation': Trainees' acts of resistance against social harm and injustice. MEDICAL EDUCATION 2024; 58:457-463. [PMID: 37975514 DOI: 10.1111/medu.15256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION As medical students around the world enter their chosen profession, they inherit a system that they did not design nor create, yet are still responsible for it. This system is rooted in centuries of social harm and inequity. This study examines trainees' professional acts of resistance to understand what trainees hope to accomplish in their resistance efforts, why they are resisting, and the tactics they use. METHODS Drawing on counter-storytelling and critical theory, we collected in-depth qualitative interviews from nine medical students and nine residents/fellows across North America. Using theoretical guidance on how to study acts of resistance, data were analysed using a combination of coding techniques to understand resistors' intentions in resisting and the tactics they used to understand what, why, and how trainees were resisting. The analysis was returned to participants for member checking. RESULTS Trainees described resisting systems of harm and injustice bequeathed to them by an older generation whose values and practices were reflective of a different time. Their motivations stemmed from deep-seated moral distress from the mistreatment of patients and learners. They hoped to re-envision medical education to be patient- and learner-centred. The tactics they chose depended on the level of power they had in the system and the extent to which they wished to have their efforts known. DISCUSSION Trainees described intentional and deliberate acts of resistance to the social harm and injustice embedded in the broader profession to re-create the profession. Given that these acts spanned a large geographical area, this study suggests that trainees may be part of a larger social movement aimed at creating widespread change within the profession.
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Affiliation(s)
- Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Vinayak Jain
- Department of Internal Medicine, MedStar Health - Georgetown Washington Hospital Center, Washington, District of Columbia, USA
| | - Ting Lan Ma
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Johnson S, Konopasky A, Wyatt T. In Their Own Voices: A Critical Narrative Review of Black Women Faculty Members' First-Person Accounts of Racial Trauma Across Higher Education. TEACHING AND LEARNING IN MEDICINE 2024:1-11. [PMID: 38511837 DOI: 10.1080/10401334.2024.2329680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
Phenomenon: Black women often face more challenges in academic medicine than others and are leaving the profession due to unsupportive work environments, systematic neglect, and experiences of invisibility. Research offers insight into Black women faculty experiences, but studies have largely been conducted on their experiences rather than written by them. We analyzed first-person narratives exploring Black women faculty members' experiences with racial trauma across the academy considering the intersectionality of racism and sexism to lay the foundation for understanding Black women physicians' faculty experiences in similar spaces. Approach: We gathered first-person narratives of Black women faculty members in the U.S. from ERIC, Web of Science, and Ovid Medline. We used a variety of terms to draw out potential experiences with trauma (e.g., microaggressions, stigma, prejudice). Articles were screened by two researchers, with a third resolving conflicts. Drawing on constructs from Black feminist theory, two researchers extracted from each article authors' claims about: (a) their institutions, (b) their experiences in those spaces, and (c) suggestions for change. We then analyzed these data through the lens of racial trauma while also noting the effects of gendered racism. Findings: We identified four key themes from the 46 first-person accounts of racial trauma of Black faculty members in higher education: pressures arising from being "the only" or "one of few"; elimination of value through the "cloak of invisibility" and "unconscious assumptions"; the psychological burden of "walking a tightrope"; and communal responsibility, asking "if not us, then who?" Insights: Black women's narratives are necessary to unearth their specific truths as individuals who experience intersectional oppression because of their marginalized racial and gender identities. This may also assist with better understanding opportunities to dismantle the oppressive structures and practices hindering more diverse, equitable, and inclusive institutional environments where their representation, voice, and experience gives space for them to thrive and not simply survive within the academy, including and not limited to medicine.
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Affiliation(s)
- Sherese Johnson
- Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Abigail Konopasky
- Department of Medical Education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Tasha Wyatt
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Feeley AA, Feeley IH, Sheehan E, Carroll C, Queally J. Impact of Mentoring for Underrepresented Groups in Undergraduate Medical Education: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:353-366. [PMID: 38160117 DOI: 10.1016/j.jsurg.2023.11.015] [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: 07/03/2023] [Revised: 10/11/2023] [Accepted: 11/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Despite efforts to mitigate challenges to advance underrepresented groups (URG) groups' representation in medical education, diversity remains underwhelming. In response to this several mentoring programs to increase diversification within medical education have been implemented. However, the impact of these programs on URG representation across disciplines is unknown. The aim of this review is to evaluate the impact of structured mentoring programs on URGs in undergraduate medical education. DESIGN Systematic review. METHODS A comprehensive search strategy was performed of electronic databases including PubMed, Ovid Medline, and EMBASE between January and September 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Both qualitative and quantitative outcomes including characteristics of the mentoring structure explored within each study were collected, and differences in study outcomes analyzed. RESULTS In total 17 studies were included for analysis. Mentoring within URGs resulted in an increase in research opportunities, exam performance, medical specialty applications, and residency matching. Structured feedback yielded positive experiences by both mentors and mentees participating in programs, with both emotional and cultural competence issues explored across studies included for analysis. CONCLUSIONS Mentoring for medical students underrepresented in medicine across mentoring relationships including peer, senior, formal, and informal structures yield positive outcomes within research, academic modules, and career pathways. Future applications of mentoring programs should consider the use of tandem mentoring from both senior and peer mentors to optimize benefits URG students derive from each mentoring relationship.
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Affiliation(s)
- Aoife A Feeley
- Connolly Hospital Blanchardstown, Dublin, Ireland; Royal College Surgeons Ireland, Dublin, Ireland.
| | - Iain H Feeley
- Midlands Regional Hospital Tullamore, Offaly, Ireland
| | - Eoin Sheehan
- Midlands Regional Hospital Tullamore, Offaly, Ireland
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McLaughlin JE, Fassett KT, Wolcott M, Rockich-Winston N, Harpe S. Methodological Challenges in Studies of Personal and Professional Identity Formation. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100583. [PMID: 37562708 DOI: 10.1016/j.ajpe.2023.100583] [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: 06/24/2022] [Revised: 12/05/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
Demographic information about the identities of faculty, staff, students, and trainees is frequently collected in pharmacy education. A wide range of identities and characteristics can influence the choices and experiences of students as they progress through curricula and develop their professional goals. Understanding personal and professional identity formation within dynamic and complex environments is critical to promoting the success of pharmacy education and practice. Emerging research efforts highlight the importance of considering identity development from varying perspectives, and offer new methods for collecting and analyzing data. The objective of this commentary is to reflect on the methodological challenges of identity formation research in pharmacy education and offer recommendations for those interested in this work.
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Affiliation(s)
- Jacqueline E McLaughlin
- University of North Carolina Eshelman, School of Pharmacy, Center for Innovative Pharmacy Education and Research, Chapel Hill, NC, USA.
| | - Kyle T Fassett
- University of North Carolina at Chapel Hill, Diversity, Equity, and Inclusion, Institutional Research and Assessment, Chapel Hill, NC, USA
| | - Michael Wolcott
- High Point University Workman School of Dental Medicine, Curriculum Innovation and Assessment, High Point, NC, USA; University of North Carolina Eshelman, School of Pharmacy, Chapel Hill, NC, USA
| | - Nicole Rockich-Winston
- Medical College of Georgia at Augusta University, Curriculum: Foundations of Medicine, Augusta, GA, USA
| | - Spencer Harpe
- Midwestern University, College of Pharmacy, Pharmacy Administration, Downers Grove, IL, USA
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Sternszus R, Slattery NK, Cruess RL, Cate OT, Hamstra SJ, Steinert Y. Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:507-516. [PMID: 37954041 PMCID: PMC10637293 DOI: 10.5334/pme.1027] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023]
Abstract
The widespread adoption of Competency-Based Medical Education (CBME) has resulted in a more explicit focus on learners' abilities to effectively demonstrate achievement of the competencies required for safe and unsupervised practice. While CBME implementation has yielded many benefits, by focusing explicitly on what learners are doing, curricula may be unintentionally overlooking who learners are becoming (i.e., the formation of their professional identities). Integrating professional identity formation (PIF) into curricula has the potential to positively influence professionalism, well-being, and inclusivity; however, issues related to the definition, assessment, and operationalization of PIF have made it difficult to embed this curricular imperative into CBME. This paper aims to outline a path towards the reconciliation of PIF and CBME to better support the development of physicians that are best suited to meet the needs of society. To begin to reconcile CBME and PIF, this paper defines three contradictions that must and can be resolved, namely: (1) CBME attends to behavioral outcomes whereas PIF attends to developmental processes; (2) CBME emphasizes standardization whereas PIF emphasizes individualization; (3) CBME organizes assessment around observed competence whereas the assessment of PIF is inherently more holistic. Subsequently, the authors identify curricular opportunities to address these contradictions, such as incorporating process-based outcomes into curricula, recognizing the individualized and contextualized nature of competence, and incorporating guided self-assessment into coaching and mentorship programs. In addition, the authors highlight future research directions related to each contradiction with the goal of reconciling 'doing' and 'being' in medical education.
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Affiliation(s)
- Robert Sternszus
- Department of Pediatrics & Institute of Health Sciences Education, McGill University, Montreal, Quebec, CA
| | | | - Richard L. Cruess
- Department of Orthopedic Surgery & Institute of Health Sciences Education, McGill University, Montreal, Quebec, CA
| | - Olle ten Cate
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht and Utrecht University, NL
| | - Stanley J. Hamstra
- Department of Surgery, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Holland Bone and Joint Program, Toronto, Canada
- ACGME, Chicago, IL, US
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Yvonne Steinert
- Department of Family Medicine & Institute of Health Sciences Education, McGill University, Montreal, Quebec, CA
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16
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Thomas T, Arif S, Franklin CJ, Iwuchukwu OF, Afolabi T. The Intersection of Professional Identity Formation, Bias, and Marginalized Identities. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100546. [PMID: 37343719 DOI: 10.1016/j.ajpe.2023.100546] [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: 08/20/2022] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES The objective of this integrative review is to call attention to the limited published literature on professional identity formation (PIF) in students who hold marginalized identities and to promote more inclusive PIF models. FINDINGS A person's identity is complicated and PIF is a dynamic and continuous lifelong process. A foundational component to PIF is for students to integrate their developing professional identity with their existing selves. Most PIF theoretical frameworks used in health education were created with a dominant culture lens and during a time when most professionals in practice were cisgendered, White, and/or male. These frameworks do not consider ways in which PIF may differ in learners who hold marginalized identities nor the influence that their marginalized identities may have on facilitators and barriers to their PIF journeys. SUMMARY PIF is a growing area of focus in pharmacy education and scholarship. To effectively support PIF for each member of a diverse student body, pharmacy educators must recognize the limitations of existing PIF theoretical frameworks owing to the historical exclusion of considerations of students' and practitioners' marginalized identities as a layer of professional identity, especially in the context of historical injustices. As members of the pharmacy Academy begin or continue to explore PIF in pharmacy education, they must be mindful and intentional about how they account for the impact that students' marginalized identities may have on their PIF.
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Affiliation(s)
- Tyan Thomas
- Saint Joseph's University - University City Campus, Philadelphia College of Pharmacy, Philadelphia, PA, USA.
| | - Sally Arif
- Midwestern University, College of Pharmacy, Downers Grove, IL, USA
| | | | - Otito F Iwuchukwu
- Fairleigh Dickinson University, School of Pharmacy and Health Sciences, Florham Park, NJ, USA
| | - Titilola Afolabi
- Midwestern University, College of Pharmacy, Glendale Campus, Glendale, AZ, USA
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Gunaseelan S, Demps E, Galvan AM, Abu-Baker A, Tanzer K, Reddy IK. A Qualitative Study of Underrepresented Minority (URM) Student Pharmacists' Intersectionality and Professional Identity Formation. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100543. [PMID: 37331515 DOI: 10.1016/j.ajpe.2023.100543] [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: 08/28/2022] [Revised: 04/10/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To determine how underrepresented minority (URM) student pharmacists' intersectionality affects professional identity formation early in their academic career. METHODS A qualitative study was undertaken. All students from Classes 2022 through 2025 at Texas A&M University School of Pharmacy were required to engage in reflection on a personal statement of philosophy of practice early in their first year of pharmacy as part of the structured longitudinal co-curricular course requirement. Statements of the URM students who referenced their intersecting identities were selected for deductive analysis per Bingham and Witkowsky and inductive analysis using Lincoln and Guba's approach to content analysis. RESULTS Of the 221 URM student pharmacists within the 4 cohorts who submitted a statement, 38 statements (92% Hispanic students) met the inclusion criteria. Student hometowns and the identity domains of the individual, relational, and collective were selected a priori for the deductive analysis. Students most often referenced individual identity characteristics that fit under the Principles I, IV, V, and VII of the Code of Ethics for Pharmacists. Three themes emerged from the inductive analysis: (1) defining experiences and resulting realizations, (2) motivating forces, and (3) aspirations as a pharmacist. A working hypothesis was developed. CONCLUSION The URM students' intersecting identities (race, ethnicity, socioeconomic class, and belonging to an underserved community) influenced their early professional identity formation. The desire to bring about racial uplift was observed among the Hispanic students as early in their P1 year through the School's required co-curricular reflection. Such reflective practice serves as an effective vehicle for the students to recognize their intersecting identities that impact their professional identity.
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Affiliation(s)
- Simi Gunaseelan
- Texas A&M University Irma Lerma Rangel School of Pharmacy, Kingsville, TX 78363, USA.
| | - Elaine Demps
- Texas A&M University Irma Lerma Rangel School of Pharmacy, Kingsville, TX 78363, USA
| | - Amanda M Galvan
- Texas A&M University Irma Lerma Rangel School of Pharmacy, Kingsville, TX 78363, USA
| | - Asim Abu-Baker
- Texas A&M University Irma Lerma Rangel School of Pharmacy, Kingsville, TX 78363, USA
| | - Kim Tanzer
- Texas A&M University Irma Lerma Rangel School of Pharmacy, Kingsville, TX 78363, USA
| | - Indra K Reddy
- Texas A&M University Irma Lerma Rangel School of Pharmacy, Kingsville, TX 78363, USA
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Sawatsky AP, Matchett CL, Hafferty FW, Cristancho S, Ilgen JS, Bynum WE, Varpio L. Professional identity struggle and ideology: A qualitative study of residents' experiences. MEDICAL EDUCATION 2023; 57:1092-1101. [PMID: 37269251 PMCID: PMC10592531 DOI: 10.1111/medu.15142] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION To enter a profession is to take on a new identity. Professional identity formation can be difficult, with medical learners struggling to adopt professional norms. The role of ideology in medical socialisation may offer insight into these tensions experienced by medical learners. Ideology is the system of ideas and representations that dominates the minds of individuals or social groups and calls individuals into certain ways of being and acting in the world. In this study, we use the concept of ideology to explore residents' experiences with identity struggle during residency. METHODS We conducted a qualitative exploration of residents in three specialties at three academic institutions in the United States. Participants engaged in a 1.5-hour session involving a rich picture drawing and one-on-one interview. Interview transcripts were coded and analysed iteratively, with developing themes compared concurrently to newly collected data. We met regularly to develop a theoretical framework to explain findings. RESULTS We identified three ways that ideology contributed to residents' identity struggle. First was the intensity of work and perceived expectations of perfectionism. Second were tensions between the developing professional identity and pre-existing personal identities. Many residents perceived messages regarding the subjugation of personal identities, including the feeling that being more than physicians was impossible. Third were instances where the imagined professional identity clashed with the reality of medical practice. Many residents described how their ideals misaligned with normative professional ideals, constraining their ability to align their practice and ideals. CONCLUSION This study uncovers an ideology that shapes residents' developing professional identity-an ideology that creates struggle as it calls them in impossible, competing or even contradictory ways. As we uncover the hidden ideology of medicine, learners, educators and institutions can play a meaningful role in supporting identity development in medical learners through dismantling and rebuilding its damaging elements.
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Affiliation(s)
- Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Frederic W Hafferty
- Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota, USA
| | - Sayra Cristancho
- Department of Surgery and Faculty of Education and scientist, Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - William E Bynum
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lara Varpio
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Perez S, Schwartz A, Hauer KE, Karani R, Hirshfield LE, McNamara M, Henry D, Lupton KL, Woods M, Teherani A. Developing Evidence for Equitable Assessment Characteristics Based on Clinical Learner Preferences Using Discrete Choice Experiments. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S108-S115. [PMID: 37983403 DOI: 10.1097/acm.0000000000005360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Medical education is only beginning to explore the factors that contribute to equitable assessment in clinical settings. Increasing knowledge about equitable assessment ensures a quality medical education experience that produces an excellent, diverse physician workforce equipped to address the health care disparities facing patients and communities. Through the lens of the Anti-Deficit Achievement framework, the authors aimed to obtain evidence for a model for equitable assessment in clinical training. METHOD A discrete choice experiment approach was used which included an instrument with 6 attributes each at 2 levels to reveal learner preferences for the inclusion of each attribute in equitable assessment. Self-identified underrepresented in medicine (UIM) and not underrepresented in medicine (non-UIM) (N = 306) fourth-year medical students and senior residents in medicine, pediatrics, and surgery at 9 institutions across the United States completed the instrument. A mixed-effects logit model was used to determine attributes learners valued most. RESULTS Participants valued the inclusion of all assessment attributes provided except for peer comparison. The most valued attribute of an equitable assessment was how learner identity, background, and trajectory were appreciated by clinical supervisors. The next most valued attributes were assessment of growth, supervisor bias training, narrative assessments, and assessment of learner's patient care, with participants willing to trade off any of the attributes to get several others. There were no significant differences in value placed on assessment attributes between UIM and non-UIM learners. Residents valued clinical supervisors valuing learner identity, background, and trajectory and clinical supervisor bias training more so than medical students. CONCLUSIONS This study offers support for the components of an antideficit-focused model for equity in assessment and informs efforts to promote UIM learner success and guide equity, diversity, and inclusion initiatives in medical education.
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Affiliation(s)
- Sandra Perez
- S. Perez is a resident, Department of Pathology, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Alan Schwartz
- A. Schwartz is the Michael Reese Endowed Professor of Medical Education, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, and director, Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN), McLean, Virginia; ORCID: http://orcid.org/0000-0003-3809-6637
| | - Karen E Hauer
- K.E. Hauer is professor, Department of Medicine, and associate dean for competency assessment and professional standards, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
| | - Reena Karani
- R. Karani is professor, Departments of Medicine, Medical Education, and Geriatrics and Palliative Medicine, and director, Institute for Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura E Hirshfield
- L.E. Hirshfield is the Dr. Georges Bordage Medical Education Faculty Scholar, associate professor, PhD program codirector, and associate director of graduate studies, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0894-2994
| | - Margaret McNamara
- M. McNamara is professor, Department of Pediatrics, and pediatric residency program director, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Duncan Henry
- D. Henry is associate professor, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Katherine L Lupton
- K.L. Lupton is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Majka Woods
- M. Woods holds the Dibrell Family Professorship in the Art of Medicine, and is assistant professor, Department of Surgery, and vice dean for academic affairs, John Sealy School of Medicine at the University of Texas Medical Branch, Galveston, Texas
| | - Arianne Teherani
- A. Teherani is professor, Department of Medicine, education scientist, Center for Faculty Educators, director of program evaluation and education continuous quality improvement, and founding codirector, University of California Center for Climate Health and Equity, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-9832
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20
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Rockich-Winston N, Robinson A, Arif SA, Steenhof N, Kellar J. The Influence of Intersectionality on Professional Identity Formation among Underrepresented Pharmacy Students. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100108. [PMID: 37597916 DOI: 10.1016/j.ajpe.2023.100108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/18/2023] [Accepted: 02/15/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The objective of this study is to explore professional identity formation (PIF) among student pharmacists from underrepresented groups (URGs). METHODS In this qualitative study, 15 student pharmacists from the University of Georgia and Midwestern University Colleges of Pharmacy were recruited for interviews to explore the influence of intersectionality of race, ethnicity, and gender on PIF. Interview data were analyzed using constructivist grounded theory to identify themes and then further analyzed using Crenshaw's theory of intersectionality, namely structural, political, and representational intersectionality. RESULTS Intersectionality of identities created situations where participants expressed advantages belonging to certain social categories, while simultaneously being disadvantaged belonging to other social categories. This awareness led to strategies to overcome these collective obstacles for themselves and their communities. Participants then described ways to shift perceptions of how society depicts pharmacists and the pharmacy profession. The results depict these processes and how intersectionality influences PIF for URG student pharmacists. CONCLUSION The sociocultural aspects of race, ethnicity, and gender influence the PIF of student pharmacists who belong to URGs. Intersectionality helps us better understand the ways in which inequality compounds itself, and this results in URG student pharmacists creating opportunities for belongingness and representation. Resultantly, URGs create opportunities for inclusivity and representation. To continue to facilitate this it is essential for educators and university systems to promote ways to foster and incorporate PIF in student pharmacists.
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Affiliation(s)
| | | | - Sally A Arif
- Midwestern University College of Pharmacy, Downers Grove, IL, USA
| | - Naomi Steenhof
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
| | - Jamie Kellar
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada
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Sullivan C, Quaintance J, Myers T, Rogers B, Gaddis M, Pirani N. A Framework to Support Medical Students' Professional Development During Large-Scale Societal Events. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:422-427. [PMID: 37237084 PMCID: PMC10218768 DOI: 10.1007/s40596-023-01795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Christine Sullivan
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | | | - Trenton Myers
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Brenda Rogers
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Monica Gaddis
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Nurbanu Pirani
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Leslie KF, Fields KS, Jones VF, Simpson RC, Boyd-Wagner S, Malcom DR. The intersectionality of professional and personal identity formation in a virtual pre-health pathway program. CURRENTS IN PHARMACY TEACHING & LEARNING 2023:S1877-1297(23)00160-0. [PMID: 37394356 DOI: 10.1016/j.cptl.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/16/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND AND PURPOSE To describe the development and implementation of professional and personal identity formation content in a virtual pre-health pathway program. EDUCATIONAL ACTIVITY AND SETTING Content within a six-week pre-health program for underrepresented and/or disadvantaged college students was redesigned to a virtual format with enhanced focus on professional and personal identity formation. Sessions on personal identity formation were also enhanced through a partnership with local mental health clinicians specializing in trauma-informed care and culturally relevant practices and strategies. FINDINGS The 2020 and 2021 programs were restructured to include pharmacy professional identity formation content around the following weekly themes: Roadmap to Pharmacy, What Does it Mean to be a Pharmacist?, Expanding Knowledge of Pharmacy, Gaining Insight and Dispelling Myths, Practicing Knowledge and Exploration, and Moving Forward. These pre-pharmacy components emphasized diversity of career paths, pharmacy-based clinical services, and the pharmacist's role in promoting health equity. Overarching components of interprofessional collaboration coupled with health policy applications further emphasized the professional identity of a pharmacist in the collaborative design and delivery of health care. New personal identity formation sessions were implemented in tandem with this content and centering around the following themes: Supporting Scholars in Self-Authorship, Building a Community among Peers, and Strategies for Coping in Times of Challenge. SUMMARY This project has the potential to serve as a model for the implementation of both personal and professional identity formation initiatives at other programs to promote pharmacy as a desirable and attainable career to pre-health students.
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Affiliation(s)
- Katie F Leslie
- Sullivan University College of Pharmacy and Health Sciences, Louisville, KY, United States.
| | - Kiana S Fields
- University of Louisville Health Sciences Center Office of Diversity and Inclusion, Louisville, KY, United States.
| | - V Faye Jones
- University of Louisville Health Sciences Center Office of Diversity and Inclusion, Louisville, KY, United States.
| | - Ryan C Simpson
- University of Louisville Health Sciences Center Office of Diversity and Inclusion, Louisville, KY, United States.
| | - Shonna Boyd-Wagner
- University of Louisville Health Sciences Center Office of Diversity and Inclusion, Louisville, KY, United States.
| | - Daniel R Malcom
- Sullivan University College of Pharmacy and Health Sciences, Louisville, KY, United States.
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Torres Acosta MA, Chandra S, Li S, Yoon E, Selgrade D, Quinn J, Ardehali H. The impact of underrepresented minority or marginalized identity status on training outcomes of MD-PhD students. BMC MEDICAL EDUCATION 2023; 23:428. [PMID: 37291579 PMCID: PMC10251672 DOI: 10.1186/s12909-023-04399-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
Dual-degree MD-PhD programs have historically lacked diversity of race, ethnicity, gender, sexual orientation, and other facets of identity. Like MD- and PhD-granting programs, MD-PhD program training environments are also marked by structural barriers that negatively impact measurable academic outcomes of underrepresented and/or marginalized students in academic medicine (racial and ethnic minority groups considered underrepresented by the National Institute of Health, sexual and gender minorities, individuals with disabilities, and individuals of low socioeconomic status). In this article, we review the existing literature on MD-PhD program disparities affecting students from these groups and provide recommendations grounded on the reviewed evidence. Our literature review identified four generalizable barriers that can impact the training outcomes of students from these marginalized and/or underrepresented groups: 1) discrimination and bias, 2) impostor syndrome and stereotype threat, 3) lack of identity-similar mentors, and 4) suboptimal institutional policies and procedures. We propose goal-oriented interventions that may begin to ameliorate the disparities present in MD-PhD program training environments that affect students from marginalized and/or underrepresented groups in academic medicine.
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Affiliation(s)
- Manuel A Torres Acosta
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA.
- Northwestern University's Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Sidhanth Chandra
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Sophia Li
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Department of Biomedical Engineering, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Esther Yoon
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Daniel Selgrade
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jeanne Quinn
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Hossein Ardehali
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA.
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Wooten RL, Gillette C, Wyatt TR, Rockich-Winston N, Crandall S. Exploring the Professional Identity Formation of Racial/Ethnic Minoritized Physician Assistants. J Physician Assist Educ 2023; 34:98-103. [PMID: 37083571 DOI: 10.1097/jpa.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
INTRODUCTION The purpose of this article is to (1) describe how professional identity intersects with physician assistants' (PAs') and PA students' racial and ethnic identities and cultural backgrounds; (2) examine how sociohistorical contexts shape professional identity in racial/ethnic minoritized PAs and PA students; and (3) identify the role of PA program administrators and faculty to address the needs of racial/ethnic minoritized PAs and PA students. METHODS This study draws on elements of constructivist grounded theory to investigate the professional identity formation (PIF) experiences of 45 PA students and alumni from 3 institutions. Participants were recruited using a snowball method and identified as 23 Black/African American, 12 Hispanic/Latino, 6 mixed race, and 4 Native American/Indigenous. Interview data were analyzed using sociocultural theory as an analytic framework. RESULTS The results suggest that participants felt that their racial/ethnic identity was an important part of their identity, yet many indicated they experienced frequent micro- and macroaggressions from fellow students, faculty, lecturers, administrators, preceptors, patients, and supervisors. Additionally, they indicated that they need more support from their programs than what is currently provided. DISCUSSION The results of this study suggest that social experiences before, during, and after PA training strongly influence PIF development in racial/ethnic minoritized PAs. Administrators and professional PA organizations should evaluate methods to support those individuals who identify as a racial/ethnic minority throughout their careers.
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Affiliation(s)
- Robert L Wooten
- Robert L. Wooten, MS, PA-C, is an assistant professor, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Chris Gillette, PhD, is an associate professor and director of research and scholarship, Department of PA Studies, Wake Forest School of Medicine, and associate professor, Department of Epidemiology and Prevention, Winston-Salem, North Carolina
- Tasha R. Wyatt, PhD, is an associate professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Nicole Rockich-Winston, PharmD, EdD, MS, is an assistant professor, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta, Georgia
- Sonia Crandall, PhD, MS, is a professor emeritus, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Chris Gillette
- Robert L. Wooten, MS, PA-C, is an assistant professor, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Chris Gillette, PhD, is an associate professor and director of research and scholarship, Department of PA Studies, Wake Forest School of Medicine, and associate professor, Department of Epidemiology and Prevention, Winston-Salem, North Carolina
- Tasha R. Wyatt, PhD, is an associate professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Nicole Rockich-Winston, PharmD, EdD, MS, is an assistant professor, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta, Georgia
- Sonia Crandall, PhD, MS, is a professor emeritus, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Tasha R Wyatt
- Robert L. Wooten, MS, PA-C, is an assistant professor, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Chris Gillette, PhD, is an associate professor and director of research and scholarship, Department of PA Studies, Wake Forest School of Medicine, and associate professor, Department of Epidemiology and Prevention, Winston-Salem, North Carolina
- Tasha R. Wyatt, PhD, is an associate professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Nicole Rockich-Winston, PharmD, EdD, MS, is an assistant professor, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta, Georgia
- Sonia Crandall, PhD, MS, is a professor emeritus, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicole Rockich-Winston
- Robert L. Wooten, MS, PA-C, is an assistant professor, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Chris Gillette, PhD, is an associate professor and director of research and scholarship, Department of PA Studies, Wake Forest School of Medicine, and associate professor, Department of Epidemiology and Prevention, Winston-Salem, North Carolina
- Tasha R. Wyatt, PhD, is an associate professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Nicole Rockich-Winston, PharmD, EdD, MS, is an assistant professor, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta, Georgia
- Sonia Crandall, PhD, MS, is a professor emeritus, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sonia Crandall
- Robert L. Wooten, MS, PA-C, is an assistant professor, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Chris Gillette, PhD, is an associate professor and director of research and scholarship, Department of PA Studies, Wake Forest School of Medicine, and associate professor, Department of Epidemiology and Prevention, Winston-Salem, North Carolina
- Tasha R. Wyatt, PhD, is an associate professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Nicole Rockich-Winston, PharmD, EdD, MS, is an assistant professor, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta, Georgia
- Sonia Crandall, PhD, MS, is a professor emeritus, Department of PA Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Cornett M, Palermo C, Ash S. Professional identity research in the health professions-a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:589-642. [PMID: 36350489 PMCID: PMC10169899 DOI: 10.1007/s10459-022-10171-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.
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Affiliation(s)
- Marian Cornett
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Susan Ash
- Monash Centre for Scholarship in Health Education, Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia
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Mokhachane M, George A, Wyatt T, Kuper A, Green-Thompson L. Rethinking professional identity formation amidst protests and social upheaval: a journey in Africa. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:427-452. [PMID: 36301374 PMCID: PMC10169886 DOI: 10.1007/s10459-022-10164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/15/2022] [Indexed: 05/11/2023]
Abstract
The under-representation of minoritized or previously oppressed groups in research challenges the current universal understanding of professional identity formation (PIF). To date, there has been no recognition of an African influence on PIF, which is crucial for understanding this phenomenon in places like South Africa, a society in which the inequity of the apartheid era still prevails. In addition, there is little data examining how social upheaval could impact PIF. This study uses interviews with medical students to explore PIF within the context of social upheaval during the 2015-2016 protests that rocked South Africa when students challenged asymmetries of power and privilege that persisted long after the country's democratic transition. The combination of the primary author's autoethnographic story, weaved into the South African sociohistorical context and ubuntu philosophy, contributes to this study of PIF in the South African context. The use of an African metaphor allowed the reorientation of PIF to reflect the influence of an ubuntu-based value system. Using the calabash as a metaphor, participants' experiences were framed and organized in two ways: a calabash worldview and the campus calabash. The calabash worldview is a multidimensional mixture of values that include ubuntu, reflections of traditional childhoods, and the image of women as igneous rocks, which recognizes the power and influence on PIF of the women who raised the participants. Introducing an African ubuntu-based perspective into the PIF discourse may redirect the acknowledgement of context and local reality in developing professional identity.
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Affiliation(s)
| | - Ann George
- University of Witwatersrand, Johannesburg, South Africa
| | - Tasha Wyatt
- Uniformed University of the Health Sciences, Bethesda, USA
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Richardson CL, Filan J, Lindsey L, Mundell A, Rathbone AP, Nazar H. Intersectional Identities: Making Sense of Skill Development on Clinical Placements. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100050. [PMID: 37288692 DOI: 10.1016/j.ajpe.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/29/2022] [Accepted: 01/11/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.
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Affiliation(s)
- Charlotte Lucy Richardson
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom.
| | - Jack Filan
- Newcastle University, Faculty of Medical Sciences, School of Medical Education, Newcastle upon Tyne, United Kingdom
| | - Laura Lindsey
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
| | - Amy Mundell
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Adam Pattison Rathbone
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
| | - Hamde Nazar
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
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McNeill IT, Carrasquilla A, Asfaw ZK, Barthélemy EJ, Mehr A, Townsend KD, Joseph A, Bederson JB, Butts GC, Germano IM. Breaking boundaries through Doctors Reaching Minority Men Exploring Neuroscience: a mentorship model to foster a pipeline for underrepresented minorities. J Neurosurg 2023; 138:533-539. [PMID: 35901743 DOI: 10.3171/2022.5.jns22196] [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: 01/23/2022] [Accepted: 05/04/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In 2015, the Association of American Medical Colleges report titled "Altering the Course: Black Males in Medicine" showed a decline in the number of Black men matriculating into medical school. To alter this trend, the authors' hypothesis was that formally exposing Black men to the clinical neurosciences during high school would enhance their chances of entering the physician workforce. For this reason, in 2007, the Doctors Reaching Minority Men Exploring Neuroscience (DR. MMEN) program was established at the Icahn School of Medicine at Mount Sinai. The program aimed to provide early exposure, mentorship, and inspiration to high school-age Black and Latinx men. The aim of this study was to evaluate the impact of the DR. MMEN program in the context of the recent race and ethnicity trends among medical school matriculants (MSMs). METHODS Association of American Medical Colleges data on MSMs stratified by race and ethnicity were reviewed for the period between 2015 and 2020. Data pertinent to the academic achievements of DR. MMEN participants, such as matriculation to college and/or medical school, were prospectively tracked and incorporated with mixed-methods exit assessment data. Qualitative responses were coded and analyzed using a thematic concept analysis method. RESULTS Over the study period, the increase of MSMs in the US was 1.0% and 1.7% for Black and Latinx individuals, respectively. Changes for the male MSM cohort were negligible: 0.3% for Black and 0.7% for Latinx. With respect to DR. MMEN, 42% of participants from 2017 to 2019 earned college scholarships, and 25% of students from the 2017-2018 cohort matriculated to a combined college-medical program. Survey data showed that 100% of DR. MMEN participants found the program useful. Analysis of qualitative data revealed that participants considered pursuing a career in neurosurgery or in another medical field. Diligence and a passion for medicine were identified as the top two most important lessons in the program, and witnessing patient satisfaction and observing a neurosurgery operation were described as the most important experiences. Participants considered availability to give advice and feedback and a passion for teaching as the principal attributes of their mentors. CONCLUSIONS Over the past 6 years, the slight increase in Black and Latinx MSMs has not been significant enough to remedy ethnoracial disparities among MSMs. In particular, Black male matriculation to medical school has remained stagnant. The DR. MMEN program is a promising model to inspire young scholars and improve diversity within neuroscience and medicine at large.
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Affiliation(s)
- Ian T McNeill
- 1Division of Neurosurgery, Department of Surgery, University of Connecticut, Farmington, Connecticut
| | - Alejandro Carrasquilla
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zerubabbel K Asfaw
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ernest J Barthélemy
- 3Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Alyson Mehr
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenya D Townsend
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Joseph
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua B Bederson
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gary C Butts
- 4Office for Diversity and Inclusion, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Isabelle M Germano
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Williams MS, Myers AK, Finuf KD, Patel VH, Marrast LM, Pekmezaris R, Martinez J. Black Physicians' Experiences with Anti-Black Racism in Healthcare Systems Explored Through An Attraction-Selection-Attrition Lens. JOURNAL OF BUSINESS AND PSYCHOLOGY 2023; 38:75-88. [PMID: 35702386 PMCID: PMC9184355 DOI: 10.1007/s10869-022-09825-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 05/05/2023]
Abstract
Anti-Black racism is a specific form of racism directed at Black people. In healthcare, there are poignant examples of anti-Black racism in the recruitment, selection, and retention stages of the job cycle. Research shows that anti-Black racism is associated with inequitable work outcomes and the under-representation of Black physicians. However, empirical findings are scattered with no organizing framework to consolidate these findings. To add to the literature, in this paper we present the attraction-selection-attrition (ASA) model (Schneider, 1987) as an organizing framework to discuss Black physicians' experiences with anti-Black racism and discrimination throughout their careers. We draw from previous literature to highlight specific experiences of Black physicians at each stage of the job cycle (i.e., attraction, selection, retention), and we offer considerations on how practitioners can mitigate anti-Black racism throughout the job cycle. In the wake of COVID-19 and highly publicized social justice movements, healthcare systems are seeking ways to increase the recruitment, selection, and retention of Black physicians to ensure health equity. We believe this guide will be valuable to practitioners, leaders, researchers, and program directions seeking to advance diversity, equity, and inclusion of Black physicians in their healthcare systems. We conclude by providing practical implications and directions for future research.
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Affiliation(s)
- Myia S. Williams
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
- Department of Medicine, Northwell Health, 600 Community Drive 4th Floor, Manhasset, NY 11030 USA
| | - Alyson K. Myers
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY USA
| | - Kayla D. Finuf
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Vidhi H. Patel
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Lyndonna M. Marrast
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY USA
| | - Johanna Martinez
- Department of Medicine, Northwell Health, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
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Baldwin CD, Lewis V, Thorndyke LE, Morahan PS, Gusic ME. Becoming by doing: How women in academic health sciences build a leadership identity through project experiences. MEDICAL TEACHER 2023; 45:73-79. [PMID: 35914521 DOI: 10.1080/0142159x.2022.2102469] [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: 06/15/2023]
Abstract
PURPOSE Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM®) program. MATERIALS AND METHODS We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes. RESULTS Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution. CONCLUSIONS We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.
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Affiliation(s)
- Constance D Baldwin
- Division of General Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivian Lewis
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Page S Morahan
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Maryellen E Gusic
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Smith CS, Stilianoudakis SC, Carrico CK. Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI). J Dent Educ 2022; 87:646-653. [PMID: 36586414 DOI: 10.1002/jdd.13159] [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: 07/10/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education. METHODS The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy. RESULTS When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513). CONCLUSION Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.
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Affiliation(s)
- Carlos S Smith
- Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, Virginia, USA.,Oral Health Equity Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Spiro C Stilianoudakis
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Caroline K Carrico
- Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,Oral Health Research Group, Virginia Commonwealth University, Richmond, Virginia, USA
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Leep Hunderfund AN, Kumbamu A, O'Brien BC, Starr SR, Dekhtyar M, Gonzalo JD, Rennke S, Ridinger H, Chang A. "Finding My Piece in That Puzzle": A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1804-1815. [PMID: 35797546 DOI: 10.1097/acm.0000000000004799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Health systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become "systems citizens"), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation. METHOD Between December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities they envisioned as future physicians, and experiences and considerations shaping their perspectives. RESULTS Most students anticipated enacting one or more systems-related roles as a future physician, categorized as "bottom-up" efforts enacted at a patient or community level (humanist, connector, steward) or "top-down" efforts enacted at a system or policy level (system improver, system scholar, policy advocate). Corresponding activities included attending to social determinants of health or serving medically underserved populations, connecting patients with team members to address systems-related barriers, stewarding health care resources, conducting quality improvement projects, researching/teaching systems topics, and advocating for policy change. Students attributed systems-related aspirations to experiences beyond HSS curricula (e.g., low-income background; work or volunteer experience; undergraduate studies; exposure to systems challenges affecting patients; supportive classmates, faculty, and institutional culture). Students also described future-oriented considerations promoting or undermining identification with systems-related roles (responsibility, affinity, ability, efficacy, priority, reality, consequences). CONCLUSIONS This study illuminates systems-related roles medical students at 4 schools with HSS curricula envisioned as part of their future physician identity and highlights past/present experiences and future-oriented considerations shaping identification with such roles. These findings inform practical strategies to support professional identity formation inclusive of systems engagement.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology and director, Learning Environment and Educational Culture, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Ashok Kumbamu
- A. Kumbamu is assistant professor of biomedical ethics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
| | - Stephanie R Starr
- S.R. Starr is associate professor of pediatrics, Mayo Clinic College of Medicine and Science, and director, Science of Health Care Delivery Education, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Michael Dekhtyar
- M. Dekhtyar is research associate, Department of Medical Education, University of Illinois College of Medicine at Chicago; ORCID: https://orcid.org/0000-0002-8548-3624
| | - Jed D Gonzalo
- J.D. Gonzalo is professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Stephanie Rennke
- S. Rennke is professor of medicine, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Heather Ridinger
- H. Ridinger is assistant professor of medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Chang
- A. Chang is professor of medicine, Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Rezaiefar P, Abou-Hamde Y, Naz F, Alborhamy YS, LaDonna KA. "Walking on eggshells": experiences of underrepresented women in medical training. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:325-332. [PMID: 36417160 PMCID: PMC9684928 DOI: 10.1007/s40037-022-00729-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Medicine remains an inequitable profession for women. Challenges are compounded for underrepresented women in medicine (UWiM), yet the complex features of underrepresentation and how they influence women's career paths remain underexplored. This qualitative study examined the experiences of trainees self-identifying as UWiM, including how navigating underrepresentation influenced their envisioned career paths. METHODS Ten UWiM family medicine trainees from one Canadian institution participated in semi-structured group interviews. Thematic analysis of the data was informed by feminist epistemology and unfolded during an iterative process of data familiarization, coding, and theme generation. RESULTS Participants identified as UWiM based on visible and invisible identity markers. All participants experienced discrimination and "otherness", but experiences differed based on how identities intersected. Participants spent considerable energy anticipating discrimination, navigating otherness, and assuming protective behaviours against real and perceived threats. Both altruism and a desire for personal safety and inclusion influenced their envisioned careers serving marginalized populations and mentoring underrepresented trainees. DISCUSSION Equity, diversity, and inclusion initiatives in medical education risk being of little value without a comprehensive and intersectional understanding of the visible and invisible identities of underrepresented trainees. UWiM trainees' accounts suggest that they experience significant identity dissonance that may result in unintended consequences if left unaddressed. Our study generated the critical awareness required for medical educators and institutions to examine their biases and meet their obligation of creating a safer and more equitable environment for UWiM trainees.
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Affiliation(s)
- Parisa Rezaiefar
- Bruyère Academic Family Health Unit, Ottawa, Ontario, Canada.
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Yara Abou-Hamde
- Bruyère Academic Family Health Unit, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Farah Naz
- Bruyère Academic Family Health Unit, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yasmine S Alborhamy
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Dace W, Purdy E, Brazil V. Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators. Adv Simul (Lond) 2022; 7:35. [PMID: 36303245 PMCID: PMC9615167 DOI: 10.1186/s41077-022-00229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Many clinicians working in healthcare simulation struggle with competing dual identities of clinician and educator, whilst those who harmonise these identities are observed to be highly effective teachers and clinicians. Professional identity formation (PIF) theories offer a conceptual framework for considering this dilemma. However, many clinician simulation educators lack practical guidance for translating these theories and are unable to develop or align their dual identities. An unusual experience involving the first author’s suspension of disbelief as a simulation facilitator sparked a novel reflection on his dual identity as a clinician and as a simulation educator. He re-framed his clinician and simulation ‘hats’ as cooperative and fluid rather than competing and compartmentalised. He recognised that these dual identities could flow between clinical and simulation environments through leaky ‘blended boundaries’ rather than being restricted by environmental demarcations. This personal story is shared and reflected upon to offer a practical ‘hats and boundaries’ model. Experimenting with the model in both clinical and simulation workplaces presents opportunities for PIF and alignment of dual identities. The model may help other clinician simulation educators navigate the complexities of merging their dual identities.
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Affiliation(s)
- William Dace
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.
| | - Eve Purdy
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Victoria Brazil
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Sims LR. Into the Unknown: Experiences of Social Newcomers Entering Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1528-1535. [PMID: 36198162 DOI: 10.1097/acm.0000000000004762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Amid efforts to diversify the medical profession, research has yet to fully explore the role of early social ties to the field. This study examined diversity through the experiences of students without early ties to medicine through family members working in health care (i.e., "newcomers") in comparison with more-connected peers (i.e., "insiders"), examining how social newcomers to medicine negotiate challenges stemming from their outsider status. METHOD The author conducted an exploratory qualitative study from 2018 to 2021 using a constructivist grounded theory approach. Following a voluntary preliminary survey of 2 cohorts of first-year medical students about their social connections in health care, the author conducted interviews over the next 2 years with students who had indicated their willingness to participate. Interviews addressed how social context shaped-and continued to influence-their journeys into medicine. Eighty second- and third-year students participated in 94 interviews, including some follow-up interviews for longitudinal insight into outsider status. Interviews from the second year (58 new, 14 follow-up) provided the foundation of the qualitative results. RESULTS Students experienced outsider status primarily on the basis of being newcomers to medicine, often compounded by intersectional characteristics, including first-generation college status, rural or low-income background, race or ethnicity, and nontraditional status. For some, an early shortage of social capital became internalized, continuing to influence confidence and belonging well into training, in line with social reproduction theory. However, newcomers also experienced benefits associated with diverse backgrounds which helped them find a sense of belonging in medicine, as suggested by community cultural wealth and antideficit perspectives. CONCLUSIONS Newcomer status proved to be a central cause of outsiderness for students from all backgrounds and warrants greater attention from stakeholders, perhaps mirroring the undergraduate focus on first-generation college-goers. Findings suggest institutions that provide robust networking and community-building opportunities are best positioned to support newcomers.
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Affiliation(s)
- Lillian R Sims
- L.R. Sims is instructor, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky; ORCID: https://orcid.org/0000-0003-1111-1649
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Zhou B, Louie AK. Beyond Humility: Empowering Minoritized Learners Through Culturally Reflective Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1299-1304. [PMID: 35583951 DOI: 10.1097/acm.0000000000004744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the wake of the Black Lives Matter and other antiracism justice movements, medical education is evolving to incorporate health equity principles for all medical students and residents, while also increasing institutional diversity recruitment of minoritized physicians. As the demographics of U.S. medical trainees shift to reflect a rapidly evolving patient population, the prevalence of culturally concordant patient-physician visits, where patients share elements of language, religion, customs, and identities with their physician, is also expected to increase. However, existing antiracist curricula are standardized to all learners and there is a dearth of cultural sensitivity training designed specifically for minoritized learners to interrogate the culturally concordant space they share with patients and mentors. In this article, the authors propose a new model for minoritized learners' cultural training, culturally reflective medicine (CRM) that identifies unanticipated tensions that may arise as minoritized learners bridge both White and Eurocentric professional and personal identities, examines how intersectionality can both strengthen encounters and lead to shared blind spots, and empowers minoritized physicians with tools for self- and group reflection to advocate for their communities. CRM is contextualized within the current landscape of cultural sensitivity training in medical education. The authors provide 2 clinical vignettes to demonstrate how CRM can unveil more nuanced understandings of health disparities than existing cultural training. As institutions work toward diversity, equity, justice, and antioppression, CRM provides a novel framework for redesigning medical education that better acknowledges and incorporates the unique knowledge of minoritized learners.
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Affiliation(s)
- Bright Zhou
- B. Zhou is a first-year family medicine resident, Stanford University-O'Connor Family Medicine Residency Program, San Jose, California; ORCID: https://orcid.org/0000-0002-0253-9179
| | - Alan K Louie
- A.K. Louie is a professor, associate chair, and director of education, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-6762-1835
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Finn GM, Brown MEL. Ova-looking feminist theory: a call for consideration within health professions education and research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:893-913. [PMID: 35389154 PMCID: PMC8988912 DOI: 10.1007/s10459-022-10108-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
The role of feminist theory in health professions education is often 'ova-looked'. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.
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Affiliation(s)
- G M Finn
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - M E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
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Wyatt TR, Rockich-Winston N, Crandall S, Wooten R, Gillette C. A comparison of professional identity experiences among minoritized medical professionals. J Natl Med Assoc 2022; 114:456-464. [PMID: 35728993 DOI: 10.1016/j.jnma.2022.05.013] [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: 01/19/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Professional identity formation (PIF) is considered a fundamental process in the development of healthcare providers. In medical education, the PIF literature has historically centered on medicine's socialization practices involving white male physicians. However, recently researchers have begun to reveal how larger socio-historical contexts influence PIF in minoritized physicians. To better understand what influences Black/African American physicians' PIF, this study compares their PIF experiences to a group of minoritized physician assistants (PAs). In comparing Black physicians' experiences to another provider, this study explored what PIF experiences may be attributed to participants' minoritized status and what might be attributed to the culture of medicine. METHODS In this cross-case analysis, 45 minoritized PA students and practicing PAs were recruited from several Southeastern universities. The PA participants included 23 Black/African Americans, 12 Latinx, 4 Indigenous/Native, and 6 of mixed races/ethnicities. Interview data were then compared to previously collected data from 41 Black/African American medical trainees and physicians. Using constant comparative method, similarities and differences in PIF were explored. RESULTS Similarities between the two groups included the importance of participants' racial/ethnic identity to patient care, experiences on-going microaggressions from patients and peers, and a desire to engage in racial uplift. However, one marked difference was found, namely that PAs felt they could bring their entire selves to the profession, whereas physicians described feeling splintered early in their training. CONCLUSIONS Several possibilities that might explain why Black physicians and minoritized PAs have this one marked difference in their PIF experience, including identity threat, internalization of different discourses, and length of training for physicians. While this study was not designed to answer this question, it is clear that there is something in the culture of medicine and the training of physicians that signals to Black physicians that they cannot bring their whole selves to the profession.
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Affiliation(s)
- T R Wyatt
- Uniformed Services University of the Health Sciences, Department of Medicine, Bethesda, Maryland, United States
| | - N Rockich-Winston
- Medical College of Georgia at Augusta University, Department of Pharmacology and Toxicology, 1120 15th Street, Augusta, Georgia 30912, United States.
| | - S Crandall
- Wake Forest School of Medicine, Department of PA Studies, Winston-Salem, NC, United States
| | - R Wooten
- Wake Forest School of Medicine, Department of PA Studies, Winston-Salem, NC, United States
| | - C Gillette
- Wake Forest School of Medicine, Department of PA Studies, Winston-Salem, NC, United States
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Rockich-Winston N, Taylor TR, Richards JA, White D, Wyatt TR. "All Patients Are Not Treated as Equal": Extending Medicine's Social Contract to Black/African American Communities. TEACHING AND LEARNING IN MEDICINE 2022; 34:238-245. [PMID: 33934678 DOI: 10.1080/10401334.2021.1902816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PHENOMENON The social contract is an implicit agreement that governs medicine's values, beliefs, and practices in ways that uphold the profession's commitment to society. While this agreement is assumed to include all patients, historical examples of medical experimentation and mistreatment suggest that medicine's social contract has not been extended to Black patients. We suggest that is because underlying medicine's contract with society is another contract; the racial contract, which favors white individuals and legitimizes the mistreatment of those who are nonwhite. When Black/African American physicians enter medicine, they enter into the social contract as an agreement with society, but must navigate the realities of the racial contract in ways that have yet to be acknowledged. This study examines how Black/African American physicians interpret and enact the social contract in light of the country's racial contract by investigating the ways in which Black/African American physicians discuss their interactions with Black patients. APPROACH This qualitative study reexamines cross-sectional data previously collected in 2018-2019 examining the professional identity formation (PIF) experiences of Black/African American trainees and physicians in the Southern part of the U.S. The goal of the larger study was to explore participants' professional identity formation experiences as racialized individuals within a predominantly white profession. The current study examines these data in light of medicine's social contract with society and Mill's (1997) theory of the racial contract to understand how Black physicians interpret and enact the social contract. Participants included 10 Black/African American students, eight residents, and nine attending physicians. FINDINGS The findings show that Black/African American physicians and trainees are aware of the country's racial contract, which has resulted in Black patients being historically excluded from what has been described in the social contract that governs all physicians. As such, they are actively working to extend the social contract so that it includes Black patients and their communities. Specifically, they engage in trust building with the Black community to make sure all patients are included. Building trust includes ensuring a consistent stream of new Black/African American trainees, and equipping Black trainees and patients with the skills needed to improve the healthcare within the Black/African American community. INSIGHTS While it been has assumed that all patients are included in the social contract between medicine and society, historical examples of medical mistreatment and experimentation demonstrate this is inaccurate; Black/African American communities have not been included. In an effort to dismantle systemic racism in the U.S., medical education must teach about its racist past and divulge how some communities have been historically excluded, providing new ways to think about how to include everyone in medicine's social contract.
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Affiliation(s)
- Nicole Rockich-Winston
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Taryn R Taylor
- Department of Pediatrics and Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Joslyn A Richards
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - DeJuan White
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Tasha R Wyatt
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Johnson M. Research as a Coping Mechanism for Racial Trauma: The Story of One Medical Student. TEACHING AND LEARNING IN MEDICINE 2022; 34:277-284. [PMID: 35723947 DOI: 10.1080/10401334.2021.1939033] [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: 12/08/2020] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 06/15/2023]
Abstract
Issue: The intersection of being a Black Woman in Medicine is a unique experience that exacerbates racial trauma and can lead to the hypervigilance, withdrawal, and emotional exhaustion that many minority students experience. Yet, there are not enough avenues for medical students like myself to healthily explore and heal from their experiences. I propose that qualitative research mentorship might be one such avenue. Evidence: It was neither my Black identity nor my female identity alone that isolated me: there were a handful of other Black students, and my school had matriculated a class that had equal numbers of men and women. Instead, it was the intersection of being Black and a woman that was unique and specific to me. As the only Black Woman in my cohort of almost 200 people, I took on a research project investigating the experiences of other Black learners. It was not until I sought out and cultivated mentors to guide me through conducting this research that I was positioned as a storyteller and a visionary to encourage future generations of those underrepresented in medicine to heal through sharing their stories and starting a ripple of change. It was empowering specifically because the qualitative research was specific to my experience. These interviews confirmed that my experience was not felt in isolation, and that I was not the only Black student doubting my abilities, qualifications, and right to be in medical school. Implication: Implementing formal qualitative mentorship programs, where medical schools encourage learners to explore some of the difficult and personal parts of their identities that address these intersections and support them, will ultimately make the universities healthier and create belonging for all students. Sharing stories through qualitative research has helped me (a) create positive experiences to achieve personal healing, (b) reveal systemic inequities, explain my individual experiences, and (c) develop agency and power to make change. Research became my most powerful coping tool and it can be just as powerful and healing for other underrepresented in medicine students. The framework I have provided can be used by institutions and faculty who strive to facilitate that healing.
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Affiliation(s)
- Monnique Johnson
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Chow CJ, Hirshfield LE, Wyatt TR. Sharpening Our Tools: Conducting Medical Education Research Using Critical Theory. TEACHING AND LEARNING IN MEDICINE 2022; 34:285-294. [PMID: 34282701 DOI: 10.1080/10401334.2021.1946401] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Issue: As medical education continues to grapple with issues of systemic racism and oppression within its institutions, educational researchers will undoubtedly turn to critical theory to help illuminate these issues. Critical theory refers both to a "school of thought" and a process of critique that reveals the dynamic forces impacting minoritized groups and individuals. Critical theory can be helpful when researchers want to examine or expose social structures for their asymmetrical power differentials, and subsequently act upon them to create change. Evidence: However, despite the repeated calls for more critical work in medical education, merely describing critical theory's school of thought has not forwarded researchers' engagement with these theories. Presently, critical analyses remain rare in medical education. One potential reason for the lack of critical analyses is that there is little guidance for how researchers might engage with their data and approach their findings. Implications: In this paper, we go beyond merely describing critical theory and demonstrate how critical theory can be used as an analytic approach to interrogate the experiences of minoritized individuals in medical education. Using three critical theories: critical race theory, feminist theory, and postcolonial theory, we provide an illustration of how researchers might approach their data using one of three critical theories. In doing so, we hope to assist researchers in better understanding the utility of critical analyses to illuminate sociohistorical forces at work within medical education.
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Affiliation(s)
- Candace J Chow
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Laura E Hirshfield
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Blalock AE, Smith MC, Patterson BR, Greenberg A, Smith BRG, Choi C. "I might not fit that doctor image": Ideal worker norms and women medical students. MEDICAL EDUCATION 2022; 56:339-348. [PMID: 34862660 DOI: 10.1111/medu.14709] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
Despite the increasing numbers of women students in medical schools, focused attention on their perceptions about medical school and the medical profession remain underexamined. These perceptions are important to understand, particularly since women students are likely burdened with a host of gender norms related to work, family, and their future roles as physicians. Early experiences in medical school offer important insights into the larger student experience and are tied to academic outcomes and feelings of belonging. To examine early experiences of women medical students, this qualitative study used sensemaking theory to describe the current context and "story" of ideal worker norms. Critical qualitative interviews of 38 women students were performed during their first 2 months of medical school and explored both how the students perceived and experienced ideal worker norms, and how they made sense of the "story" of ideal worker norms. The participants described ways they encountered gendering and ideal worker norms through displays of nurturing behaviour, expectations to balance a future family, and whether they looked or acted the part of a doctor. This article highlights the challenges women medical students are already aware they will face, the opportunities they look forward to, and the strengths they anticipate leaning on to navigate their profession. Results from this study have implications for women medical students' learning experiences and transitions into medical school and for faculty, staff, and scholars concerned with challenging gendering norms that shape medical education.
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Affiliation(s)
- A Emiko Blalock
- Office of Medical Education Research and Development, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | | | - B R Patterson
- Premed, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Amy Greenberg
- Office of Medical Education Research and Development, Office of Academic Affairs, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Brandon R G Smith
- Higher Adult and Lifelong Education, Michigan State University, East Lansing, Michigan, USA
| | - Christine Choi
- Student Affairs, Michigan State University, East Lansing, Michigan, USA
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Wyatt TR, Zaidi Z. Bricolage: A tool for race-related, historically situated complex research. MEDICAL EDUCATION 2022; 56:170-175. [PMID: 34514622 DOI: 10.1111/medu.14629] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND As medical education grapples with larger issues of race and racism, researchers will need new tools to capture society's complex issues. One promising approach is bricolage, a methodological and theoretical approach that allows researchers to bend analytical tools to meet their needs. Bricolage is both a metaphor and an activity to describe the cognitively creative process researchers engage in while conducting interdisciplinary and multidimensional research. PROCESS At the heart of bricolage is the researchers' engagement in critical hermeneutics, which at its basic level recognises that all objects under study are subject to larger social, political, and historical forces that constrain individuals. Researching with bricolage treats objects of inquiry as part of a historically situated complex system. As such, data are interpreted in ways that build conceptual bridges between individuals' concrete experiences and concepts acknowledging larger social, historical, economic, and political forces. PEARLS To engage in bricolage, researchers should begin by reading and comparing ideas across disciplines to expose disciplinary-specific assumptions, as well as learn about new theories, approaches and methods that might be utilised for a bricolage project. Researchers should also ask themselves philosophical questions to identify new readings or their data. And finally, researchers should experiment with analytical metaphors because they help to frame new relationships between seemingly unrelated theories, methods and concepts. As researchers engage in bricolage, they need to sidestep their training and over-reliance on research protocols and checklists and engage in a creative tinkering to interpret the world in new ways. In doing so, scholars will be able to push traditional research boundaries and generate critical dialogue to move the field forward.
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Affiliation(s)
- Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Zareen Zaidi
- College of Medicine, University of Florida, Gainesville, Florida, USA
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Davenport D, Alvarez A, Natesan S, Caldwell M, Gallegos M, Landry A, Parsons M, Gottlieb M. Faculty Recruitment, Retention, and Representation in Leadership: An Evidence-Based Guide to Best Practices for Diversity, Equity, and Inclusion from the Council of Residency Directors in Emergency Medicine. West J Emerg Med 2022; 23:62-71. [PMID: 35060865 PMCID: PMC8782137 DOI: 10.5811/westjem.2021.8.53754] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
Improving the recruitment, retention, and leadership advancement of faculty who are under-represented in medicine is a priority at many academic institutions to ensure excellence in patient care, research, and health equity. Here we provide a critical review of the literature and offer evidence-based guidelines for faculty recruitment, retention, and representation in leadership. Recommendations for recruitment include targeted recruitment to expand the candidate pool with diverse candidates, holistic review of applications, and incentivizing stakeholders for success with diversity efforts. Retention efforts should establish a culture of inclusivity, promote faculty development, and evaluate for biases in the promotion and tenure process. We believe this guide will be valuable for all leaders and faculty members seeking to advance diversity, equity, and inclusion in their institutions.
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Affiliation(s)
- Dayle Davenport
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
| | - Al’ai Alvarez
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Sreeja Natesan
- Duke University School of Medicine, Division of Emergency Medicine, Durham, North Carolina
| | - Martina Caldwell
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
| | - Moises Gallegos
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Adaira Landry
- Harvard University School of Medicine, Division of Emergency Medicine, Boston, Massachusetts
| | - Melissa Parsons
- University of Florida School of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Fyfe M, Horsburgh J, Blitz J, Chiavaroli N, Kumar S, Cleland J. The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:1-14. [PMID: 34964930 PMCID: PMC8714874 DOI: 10.1007/s40037-021-00696-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research. METHODS Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows. RESULTS We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices). CONCLUSIONS Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.
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Affiliation(s)
- Molly Fyfe
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Sonia Kumar
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Bochatay N, Bajwa NM, Ju M, Appelbaum NP, van Schaik SM. Towards equitable learning environments for medical education: Bias and the intersection of social identities. MEDICAL EDUCATION 2022; 56:82-90. [PMID: 34309905 DOI: 10.1111/medu.14602] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences. METHODS This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities. RESULTS Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management. CONCLUSIONS Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.
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Affiliation(s)
- Naike Bochatay
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Nadia M Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Mindy Ju
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Nital P Appelbaum
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, Texas, USA
| | - Sandrijn M van Schaik
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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Konopasky A, Varpio L, Stalmeijer RE. The potential of narrative analysis for HPE research: Highlighting five analytic lenses. MEDICAL EDUCATION 2021; 55:1369-1375. [PMID: 34291492 DOI: 10.1111/medu.14597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/06/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Health professions education (HPE) has increasingly turned to qualitative methodology to address a number of the field's difficult research problems. While several different methodologies have been widely accepted and used in HPE research (e.g., Grounded Theory), others remain largely unknown. In this methodology paper, we discuss the value of narrative analysis (NA) as a set of analytic approaches that offer several lenses that can support HPE scholars' research. METHODS After briefly discussing the 'narrative turn' in research, we highlight five NA lenses: holistic, situated, linguistic, agentive and sequential. We explore what each lens can offer HPE scholars-highlighting certain aspects of the data-and how each lens is limited-obscuring other aspects. To support these observations, we offer an example of each lens from contemporary HPE scholarship. The manuscript also describes methods that can be employed in NA research and offers two different typologies of NA methods that can be used to access these lenses. CONCLUSIONS We conclude with a discussion of how different analytic methods can be used to harness each of the lenses. We urge the deliberate selection and use of NA methods and point to the inherent partiality of any NA approach. Reflecting on our position as narrative scholars, we acknowledge how our own lenses illuminate some areas and conceal others as we tell the story of NA. In conclusion, we invite other researchers to benefit from the potential NA promises.
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Affiliation(s)
- Abigail Konopasky
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
- Center for Health Professions Education, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Lara Varpio
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
| | - Renée E Stalmeijer
- School of Health Professions Education, Department for Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Zhou C, Okafor C, Hagood J, DeLisser HM. Penn Access Summer Scholars program: a mixed method analysis of a virtual offering of a premedical diversity summer enrichment program. MEDICAL EDUCATION ONLINE 2021; 26:1905918. [PMID: 33789548 PMCID: PMC8018359 DOI: 10.1080/10872981.2021.1905918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
In the USA, numerous summer programs are available for undergraduate students that seek to increase the number of individuals from groups underrepresented in medicine (URM) that matriculate to medical school. These programs have typically been conducted at research-focused institutions, involving hands-on-research and various enrichment experiences. For 2020, the COVID-19 pandemic resulted in the suspension of on-campus student activities at American universities, necessitating a switch to a virtual format for these URM-focused programs. Outcomes, however, from these programs conducted virtually, necessitated by the COVID-19 pandemic, have not been reported. The Penn Access Summer Scholars (PASS) program at the Perelman School of Medicine (PSOM) targets URM undergraduates, providing two consecutive summers of mentored research and enrichment experiences, with the goal of enabling participants' matriculation to PSOM. PASS has been an 8 week on-campus experience, but during summer 2020, virtual programming of 6 weeks was provided due to the COVID-19 pandemic. Participants in the 2020 virtual offering of PASS completed pre- and post-program surveys that included 5-point Likert-style and open-ended questions to determine the impact of the programing on self-assessments of research skills, familiarity with the physician identity, and preparedness to be a PSOM student. Post-program, participants also assessed program administration and content. With respect to program objectives, participants reported significant increases in their self-reported confidence in conducting research, understanding of physician identity, and sense of preparedness for medical school. The educational value of the program content, their level of engagement in the program and the overall quality of the program were rated as excellent or outstanding by large majorities of respondents. Content analyses of participant comments were consistent with these quantitative results. Therefore, a premedical summer enrichment program targeting URM undergraduates can be successfully conducted virtually to achieve program objectives and may increase the availability to these initiatives.
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Affiliation(s)
- Cecilia Zhou
- Program for Diversity and Inclusion, Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chielozor Okafor
- Program for Diversity and Inclusion, Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jamal Hagood
- Program for Diversity and Inclusion, Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Horace M. DeLisser
- Program for Diversity and Inclusion, Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Wyatt TR, Taylor TR, White D, Rockich-Winston N. "When No One Sees You as Black": The Effect of Racial Violence on Black Trainees and Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S17-S22. [PMID: 34348386 DOI: 10.1097/acm.0000000000004263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The United States has an implicit agreement known as the racial contract that exists between white and non-white communities. Recently, the racial contract has produced much tension, expressed in racial violence and police brutality. This study explores how this racial violence and police brutality have affected the practice and education of Black trainees and physicians who are members of the racial community being targeted. METHOD This qualitative cross-sectional study interviewed 7 Black trainees and 12 physicians from 2 Southern medical schools in 2020. Interview data were collected using aspects of constructivist grounded theory, and then analyzed using the concept of racial trauma; a form of race-based stress minoritized individuals experience as a result of inferior treatment in society. Data were then organized by the causes participants cited for feeling unsafe, conditions they cited as producing these feelings, and the consequences these feelings had on their education and practice. RESULTS The results show that even though participants were not direct victims of racial violence, because their social identity is linked to the Black community, they experienced these events vicariously. The increase in racial violence triggered unresolved personal and collective memories of intergenerational racial trauma, feelings of retraumatization after more than 400 years of mistreatment, and an awakening to the fact that the white community was unaware of their current and historical trauma. These events were felt in both their personal and professional lives. CONCLUSIONS As more minoritized physicians enter medicine and medical education, the profession needs a deeper understanding of their unique experiences and sociohistorical contexts, and the effect that these contexts have on their education and practice. While all community members are responsible for this, leaders play an important role in creating psychologically safe places where issues of systemic racism can be addressed.
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Affiliation(s)
- Tasha R Wyatt
- T.R. Wyatt is associate professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-0071-5298
| | - Taryn R Taylor
- T.R. Taylor is assistant professor of pediatrics and emergency medicine, Emory University School of Medicine, Atlanta, Georgia; ORCID: https://orcid.org/0000-0001-8099-900X
| | - DeJuan White
- D. White is assistant professor of psychiatry and director of psychiatric emergency services, Emory University School of Medicine, Atlanta, Georgia; ORCID: https://orcid.org/0000-0003-0637-1294
| | - Nicole Rockich-Winston
- N. Rockich-Winston is assistant professor of pharmacology, Medical College of Georgia, Augusta, Georgia; ORCID: https://orcid.org/0000-0002-2898-4393
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Abstract
Professional identity formation (PIF) is a dynamic developmental process by which individuals merge the knowledge and skills of clinical practice with the values and behaviors of their personal identity. For an individual physician, this process is a continuum which begins with their nascent interest in the field of medicine and extends through the end stages of a medical career. The impact of PIF has become a growing focus of medical education research in the last decade, and in that time, little attention has been paid to the influence underrepresented in medicine (UIM) identities may have on this fundamental process. Importantly, in discussions of how medical educators can support and encourage successful PIF, there is little discussion on the distinct challenges and different needs UIM learners may have. The purpose of this paper is to address the current literature around PIF for UIM trainees. This review explores various threats to identity formation, including identity fusion, stereotype threat, minority tax, implicit bias, and lack of mentorship. Evidence-based strategies to mitigate these challenges is also presented, including furthering institutional support for PIF, building the community of practice, supporting an inclusive environment, and developing PIF assessment tools. Through exploring these challenges and solutions, we are better able to address the needs of UIM trainees and physicians as they proceed in their PIF during their lifelong journey in medicine.
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