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Lujan HL, DiCarlo SE. Misunderstanding of race as biology has deep negative biological and social consequences. Exp Physiol 2024; 109:1240-1243. [PMID: 38698766 PMCID: PMC11291859 DOI: 10.1113/ep091491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Heidi L. Lujan
- Department of Physiology, College of Osteopathic MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Stephen E. DiCarlo
- Department of Physiology, College of Osteopathic MedicineMichigan State UniversityEast LansingMichiganUSA
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Ruedinger E, Evans YN, Pham DQ, Hooper L. Just-in-Time Strategies to Reduce the Effect of Interviewer Bias During Trainee Recruitment. Acad Pediatr 2024; 24:709-713. [PMID: 38280713 DOI: 10.1016/j.acap.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
Bias impacts all aspects of medical trainee applications, from grades to narrative reviews. Interviews provide an avenue to become acquainted with applicants beyond their written application, but even the most egalitarian interviewers are subject to implicit biases, including those who hold marginalized identities themselves. Simply building awareness around implicit bias is inadequate to reduce the effect. Here, 5 evidence-informed strategies are presented that can be implemented by faculty on-the-spot to mitigate the impact of implicit bias during the short interview interaction: individuation, mindfulness, perspective taking, stereotype replacement, and counter-stereotypic imaging. These strategies can be used by individual interviewers as one component of a comprehensive plan including institutional changes to promote more equitable recruitment processes.
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Affiliation(s)
- Emily Ruedinger
- Department of Pediatrics (E Ruedinger), University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Yolanda N Evans
- Department of Pediatrics (YN Evans), University of Washington School of Medicine, Seattle, Wash.
| | - Do-Quyen Pham
- Division of School Health and Maternal and Child Health (D-Q Pham), Fairfax County Health Department, Fairfax, Va.
| | - Laura Hooper
- Division of Adolescent Medicine (L Hooper), Indiana University, Indianapolis, Ind.
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Irani S, Zebib L, Simons ECG, Andino JJ, Palapattu G, Goh KM. Analyzing the Current State and Visibility of Diversity, Equity, and Inclusion Initiatives at Urology Residency Programs. Urology 2024; 188:24-29. [PMID: 38508531 DOI: 10.1016/j.urology.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To analyze AUA urology residency program websites to determine visibility of diversity, equity, and inclusion (DEI) initiatives. There is growing interest in DEI initiatives by urology applicants, and in recent years, urology programs have invested in efforts to promote DEI. METHODS All ACGME-accredited urology residency program with a website were assessed. Military programs were excluded. A DEI Score Card was developed using published pillars of DEI, including five domains: departmental inclusion, pipeline growth, departmental education, community engagement, and faculty demographics. Program Doximity rank, address, and surrounding demographics were collected to determine predictors of investing in DEI. RESULTS One hundred forty-one urology residency websites were included for analysis. Only 40.7% of programs referenced DEI on their webpage, and 21.4% offered funded mentorship opportunities. Department education and community engagement were the least popular initiatives. The Western, Northeastern, and North Central sections had the highest DEI total score with wide variation across domains. Mention of DEI was not associated with program's county-level social vulnerability or percent minority but was associated with being a top 50 program (OR=4.0; 95% CI 1.8, 8.9; P = .0007). CONCLUSION Less than half of academic urology programs' websites referenced DEI initiatives. Using a DEI score card, our study shows that investment in DEI varies widely by AUA section, and greater investment is positively correlated with program rank. Our DEI score card serves as a tool that programs can use to assess their current DEI investment, identify areas for improvement, and ensure existing initiatives are visible to applicants.
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Affiliation(s)
- Sarosh Irani
- University of Michigan Medical School, Ann Arbor, MI
| | - Laura Zebib
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Juan J Andino
- University of California Los Angeles, Department of Urology, Los Angeles, CA
| | | | - Keow Mei Goh
- Department of Urology, University of Michigan, Ann Arbor, MI.
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GiglioAyers P, Foley CE, Cronin B, Burrell D. Investigating racial/ethnic differences in procedure experience in obstetrics & gynecology trainees at a single academic institution: a retrospective cohort study. BMC MEDICAL EDUCATION 2024; 24:561. [PMID: 38783287 PMCID: PMC11118719 DOI: 10.1186/s12909-024-05363-9] [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: 06/07/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Discrimination is common in medical education. Resident physicians of races and ethnicities underrepresented in medicine experience daily discrimination which has been proven to negatively impact training. There is limited data on the impact of resident race/ethnicity on OB/GYN surgical training. The objective of this study was to investigate the impact of race/ethnicity on procedural experience in OB/GYN training. METHODS A retrospective analysis of graduated OB/GYN resident case logs from 2009 to 2019 was performed at a single urban academic institution. Self-reported race/ethnicity data was collected. Association between URM and non-URM were analyzed using t-tests. Trainees were categorized by self-reported race/ethnicity into underrepresented in medicine (URM) (Black, Hispanic, Native American) and non-URM (White, Asian). RESULTS The cohort consisted of 84 residents: 19% URM (N = 16) and 79% non-URM (n = 66). Difference between URM and non-URM status and average case volume was analyzed using t-tests. There was no difference between non-URM and URM trainees and reported mean number of Total GYN (349 vs. 334, p = 0.31) and Total OB (624 vs. 597, P = 0.11) case logs. However, compared with non-URM, on average URM performed fewer Total procedures (1562 vs. 1469, P = 0.04). Analyzing individual procedures showed a difference in average number of abortions performed between URM and non-URM (76 vs. 53, P = 0.02). There were no other statistically significant differences between the two groups. CONCLUSIONS This single institution study highlights potential differences in trainee experience by race/ethnicity. Larger national studies are warranted to further explore these differences to identify bias and discrimination, and to ensure equitable experience for all trainees.
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Affiliation(s)
- Patricia GiglioAyers
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA.
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA.
| | - Christine E Foley
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA
| | - Beth Cronin
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, USA
| | - Dayna Burrell
- Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley St, 02905, Providence, RI, USA
- The Warren Alpert Medical School of Brown University, 222 Richmond Street, 02903, Providence, RI, 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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Marr M, Bruinsma TJ, Spigner ST, Rojo J, Keyes T. Student-Led Webinar to Support LGBTQ+ Students Applying to Medical School During the COVID-19 Pandemic. JOURNAL OF HOMOSEXUALITY 2024; 71:1057-1070. [PMID: 36625541 PMCID: PMC10330930 DOI: 10.1080/00918369.2022.2160942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer, intersex, asexual, non-binary, two-spirit, and other (LGBTQ+) students are a diverse group with unique and frequently overlooked needs in medical training. The present study was designed to understand the concerns of LGBTQ+ applicants to medical school and examine the effectiveness of a webinar in alleviating concerns. Sixty participants joined webinars discussing the medical school application process with particular attention to concerns pertinent to the LGBTQ+ population. Pre and post surveys were administered to examine webinar effectiveness and participant concerns. Results were analyzed using quantitative and qualitative methods. Pre-medical students reported that the webinar format was helpful for their application process. Specifically, pre- and post-test analyses revealed that the webinar increased both students' preparedness as well as their confidence in disclosing their LGBTQ+ identity or being "out" when applying to medical school. Student-led, online webinars increase LGBTQ+ students' confidence and help address SGM students' concerns about applying to medical school.
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Affiliation(s)
- Mollie Marr
- Medical Scientist Training Program, Oregon Health & Science University, Portland, OR, USA
| | - T. J. Bruinsma
- Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - S. T. Spigner
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - J. Rojo
- School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - T. Keyes
- Medical Scientist Training Program, Stanford University School of Medicine, Stanford, CA, USA
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Arno K, Bradby C, Shappell E, Mannix A, Fix M, Jordan J, Cooney R, Krzyzaniak SM, Gottlieb M. Differences in emergency medicine resident procedural reporting by race and ethnicity. AEM EDUCATION AND TRAINING 2024; 8:e10930. [PMID: 38235392 PMCID: PMC10790187 DOI: 10.1002/aet2.10930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 01/19/2024]
Abstract
Background The recruitment, retention, and training of physicians from groups underrepresented in medicine (UiM) is critically important to the practice of emergency medicine (EM). Studies across specialties have demonstrated disparities in operative experiences among UiM resident learners who are UiM; however, there are limited data on procedural disparities in EM. Objective We sought to quantify the association between racial and ethnic identities that are UiM and the number of procedures reported among EM residents. Methods We conducted a retrospective review of procedural differences by UiM status (using self-identified race and ethnicity) among graduating EM residents at nine training programs over a 10-year period. Sites were selected to ensure diversity of program length, program type, and geography. Data from residents in combined training programs, those who did not complete their full training at that institution, and those with missing data or electing not to report race/ethnicity were excluded. We calculated median and interquartile ranges for each procedure by UiM status. We conducted multivariable regression analyses accounting for UiM status, gender, and site as well as a sensitivity analysis excluding values >3 standard deviations from the mean for each procedure. Results We collected data from 988 total residents, with 718 (73%) being non-UiM, 204 (21%) being UiM, 48 (5%) electing not to specific race/ethnicity, and 18 (2%) missing race/ethnicity data. While unadjusted data demonstrated a difference between UiM and non-UiM resident numbers across several procedures, there were no significant differences in procedures reported after accounting for gender and site in the primary or sensitivity analyses. Conclusions We did not identify a statistically significant difference in reported procedures between UiM and non-UiM residents in EM. Future work should include qualitative investigations of UiM resident experience surrounding procedures as well as mixed-methods studies to examine how these data interact.
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Affiliation(s)
- Kimbia Arno
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNew YorkUSA
| | - Cassandra Bradby
- Department of Emergency MedicineThe Brody School of Medicine at East Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Eric Shappell
- Department of Emergency MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra Mannix
- Department of Emergency MedicineUniversity of Florida College of Medicine–JacksonvilleJacksonvilleFloridaUSA
| | - Megan Fix
- Department of Emergency MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Jaime Jordan
- Department of Emergency MedicineDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Robert Cooney
- Emergency MedicineGeisinger Medical CenterDanvillePennsylvaniaUSA
| | - Sara M. Krzyzaniak
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
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Ravulapalli KC, Arroyave Caicedo NM, Zahra D, Mirza M. Quantitative Analysis of Challenges Encountered by UK Widening Participation Medical Students in Comparison With Their Non-Widening Participation Peers. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241249012. [PMID: 38808124 PMCID: PMC11131392 DOI: 10.1177/23821205241249012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/05/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Few studies have captured the experiences of widening participation (WP) medical students, and none have compared their experiences to their non-WP peers. This study aims to identify which challenges WP students are more likely to face. METHODS A 22-item questionnaire was distributed to medical students across all UK medical schools. Students were asked yes or no questions on whether they faced challenges in finances, socializing, physical and mental health, academic attainment, and COVID19-related teaching changes. RESULTS One-hundred seventy-six medical students from all year groups across the UK responded, with 97 students from a WP background. WP students were significantly more likely to have their personal background impacting their mental health (OR = 2.65, WP = 0.002), more than twice as likely to feel that their job impacted their studies (OR = 2.53, P ≤.05), more likely to feel limited by their financial situation (OR = 2.29, P≤.05) and to receive support from student finance (OR = 2.08, P < .05). CONCLUSION WP students were more likely to face challenges in mental health and finances in medical school compared to their peers. These findings, further informed by qualitative insights can aid in advancing equity in medical training.
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [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: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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Melro CM, Pack R, MacLeod A, Rideout A, Watson-Creed G, Burm S. Front row seat: The role MMI assessors play in widening access to medical school. MEDICAL TEACHER 2023:1-8. [PMID: 38100759 DOI: 10.1080/0142159x.2023.2289851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND While many medical schools utilize the Multiple Mini-Interview (MMI) to help select a diverse student body, we know little about MMI assessors' roles. Do MMI assessors carry unique insights on widening access (WA) to medical school? Herein we discuss the hidden expertise and insights that assessors contribute to the conversation around WA. METHODS Ten MMI assessors (1-10 years' experience) participated in semi-structured interviews exploring factors influencing equitable medical school recruitment. Given their thoughtfulness during initial interviews, we invited them for follow-up interviews to gain further insight into their perceived role in WA. Fourteen interviews were conducted and analyzed using a thematic analysis approach. RESULTS Assessors expressed concerns with diversity in medicine; dissatisfaction with the status quo fueled their contributions to the selection process. Assessors advocated for greater diversity among the assessor pool, citing benefits for all students, not only those from underrepresented groups. They noted that good intentions were not enough and that medical schools can do more to include underrepresented groups' perspectives in the admissions process. CONCLUSION Our analysis reveals that MMI assessors are committed to WA and make thoughtful contributions to the selection process. A medical school selection process, inclusive of assessors' expertise is an important step in WA.
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Affiliation(s)
- Carolyn M Melro
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rachael Pack
- Centre for Education Research & Innovation, Western University, London, Ontario, Canada
| | - Anna MacLeod
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Rideout
- Admissions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gaynor Watson-Creed
- Serving and Engaging Society, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Burm
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
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Flier LA, Richards JB, Hacker MR, Hovaguimian A, Vanka A, Sullivan A, Royce CS. "Should I Say Something?": A Simulation Curriculum on Addressing Lapses in Professionalism to Improve Patient Safety. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11359. [PMID: 38089936 PMCID: PMC10713868 DOI: 10.15766/mep_2374-8265.11359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Introduction Medical students may witness lapses in professionalism but lack tools to effectively address such episodes. Current professionalism curricula lack opportunities to practice communication skills in addressing professionalism lapses. Methods We designed a simulation curriculum to introduce professionalism expectations, provide communication tools using elements of the Agency for Healthcare Research and Quality TeamSTEPPS program, and address observed professionalism lapses involving patient safety in hierarchical patient care teams. Students were surveyed on knowledge, skills, and attitude regarding professionalism before, immediately after, and 6 months after participation. Results Of 253 students, 70 (28%) completed baseline and immediate postsurveys, and 39 (15%) completed all surveys. In immediate postsurveys, knowledge of communication tools (82% to 94%, p = .003) and empowerment to address residents (19% to 44%, p = .001) and attendings (15% to 39%, p < .001) increased. At 6 months, 96% of students reported witnessing a professionalism lapse. Discussion The curriculum was successful in reported gains in knowledge of communication tools and empowerment to address professionalism lapses, but few students reported using the techniques to address witnessed lapses in real life.
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Affiliation(s)
- Lydia A. Flier
- Instructor, Department of Medicine, Mount Auburn Hospital and Harvard Medical School
| | - Jeremy B. Richards
- Assistant Professor of Medicine, Harvard Medical School and Mount Auburn Hospital
| | - Michele R. Hacker
- Associate Professor, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Alexandra Hovaguimian
- Assistant Professor, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Anita Vanka
- Assistant Professor, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Amy Sullivan
- Director of Education Research, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Celeste S. Royce
- Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
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Edwell A, Van Schaik S, Teherani A. URM: Underrepresented or Underrecognized? A Case Study of Black Pediatric Critical Care Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S50-S57. [PMID: 37983396 DOI: 10.1097/acm.0000000000005370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE This study explored Black physicians' experience via an antideficit lens to gain new ideas for advancing minoritized physicians in academic medicine more broadly. Increasingly, systemic racism in academic medicine is intentionally acknowledged and named. However, many solutions to tackle racism and the overall paucity of Black physicians use a deficit framing, painting Black physicians and trainees as lacking preparation, interest, or experience and qualifications. Such solutions aim to help Black people assimilate into the "White Space" of academic medicine, rather than focusing on Black people's strengths. METHOD This qualitative study included 15 Black physicians and trainees in pediatric critical care medicine (PCCM) from across the country who participated in semistructured interviews. Through an antideficit lens, the researchers examined the social, cultural, and structural contexts influencing the participants' individual experiences. They analyzed the data combining thematic and narrative qualitative analysis approaches, including restorying. RESULTS The data help promote understanding of the landscape and context in which Black PCCM physicians become successful. Achievement took on different forms for the participants. Participants described enablers of achievement that supported them through their individual journeys spanning 3 general domains-intrinsic, interpersonal, and systemic. Three additional enablers were tied specifically to participants' Black identities-harnessing Blackness as a superpower, leaning in to lead, and successfully navigating the "unwritten rules." CONCLUSIONS By using an antideficit framework, this study delineates and centers participants' ingenuity in cultivating repertoires of practice that enabled them to succeed, despite challenges rooted in systemic racism. Going forward, rather than focus solely on what is missing, academic medicine should try to shift systems and regularly recognize and value the knowledge, expertise, and merit Black that physicians bring. Perhaps an appropriate framing is not that Black physicians are underrepresented in medicine; maybe instead, it is that they are underrecognized.
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Affiliation(s)
- April Edwell
- A. Edwell is assistant professor of pediatrics, Department of Pediatrics, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Sandrijn Van Schaik
- S. Van Schaik is professor of pediatrics, Department of Pediatrics, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Arianne Teherani
- A. Teherani is professor of medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-983
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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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14
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Morrison N, Machado M, Blackburn C. Bridging the gap: Understanding the barriers and facilitators to performance for Black, Asian and Minority Ethnic medical students in the United Kingdom. MEDICAL EDUCATION 2023. [PMID: 37807122 DOI: 10.1111/medu.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Differential attainment is a well-known phenomenon in medical education. Despite a strong impetus for institutions and researchers to move away from a 'student deficit model' when exploring the attainment gap, little attention has been given to understanding the experiences of Black, Asian and Minority Ethnic (BAME) medical students. Informed by the social construction of learning theory, this is the first national study to explore how multiple dimensions of the medical school environment impact academic performance of BAME undergraduate medical students across the UK. METHODS Using a sequential explanatory mixed-methods approach, the authors conducted a survey and facilitated three focus groups across medical schools in the UK between 2020-2021. Participants self-identified as being from BAME backgrounds. Quantitative analyses included descriptive statistics and bivariate analyses. Qualitative data were analysed using thematic analysis, subsequently identifying inductive themes. RESULTS Three hundred sixty-two respondents completed the Phase 1 survey, and 17 participants participated in the Phase 2 focus groups. Although both survey and focus group participants identified facilitators to learning such as supportive relationships, students reported facing numerous barriers that they felt impeded their learning and performance. These barriers included limited access to educational resources, and undiversified curricula and medical school populations. Students also described both experiencing and witnessing various forms of racism throughout their educational journeys. DISCUSSION Students encountered various difficulties throughout their medical training that they felt impacted their learning and performance. This study offers novel insights into the experiences of BAME students and builds upon previous research. It also reveals the pervasive nature of racism within medical schools, highlighting the urgent need for institutional changes. Educators and institutions must go beyond merely recognising these barriers and facilitators; they must proactively innovate and adapt. In doing so, they pave the way for inclusive learning environments that truly foster a sense of belonging for BAME students.
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Affiliation(s)
- Nariell Morrison
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Education, University of Oxford, Oxford, UK
| | - Michelle Machado
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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15
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Swain W, Calac AJ, Neimeko CJ, Gasca L, Dodge Francis C. Understanding the Experiences of American Indian and Alaska Native Students Enrolled in Allopathic and Osteopathic Medical Degree Programs. J Racial Ethn Health Disparities 2023; 10:2145-2154. [PMID: 35976606 DOI: 10.1007/s40615-022-01394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Despite a growing population, American Indian and Alaska Native (AI/AN) students have seen no meaningful increase in representation in allopathic and osteopathic medical degree programs. While AI/AN medical students are more likely to practice in underserved areas, they face financial and sociocultural obstacles towards doing so. This underscores the need to understand the experiences of these trainees, and identify barriers and facilitators to the successful recruitment, retention, and advancement of AI/AN trainees. METHODS A survey was administered to members of the Association of Native American Medical Students (ANAMS), an organization representing self-identified Native medical students. This survey elicited demographic information, opinions of institutional climate, and aspects of academic and social experiences during medical school. RESULTS There were n = 39 complete responses. Over fifty percent of respondents (n = 21) identified as AI/AN alone and not in combination with another racial or ethnic group. Overall, respondents were: Generally, not satisfied with their school's engagement with Native communities and AI/AN health curricula. Likely to report barriers towards their timely advancement in training, namely being a first-generation or low income student, and feelings of imposter syndrome. Likely to report an interest to work in primary care fields and serve AI/AN communities in the future. CONCLUSIONS This survey identified several barriers to successful AI/AN medical trainee advancement, highlighting opportunities for institutions to foster inclusion of AI/AN trainees and grow the number of Native physicians.
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Affiliation(s)
| | - Alec J Calac
- University of California San Diego School of Medicine, San Diego, CA, USA
- University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, San Diego, CA, USA
| | - Carmen J Neimeko
- University of Wisconsin-Madison School of Human Ecology, Madison, WI, USA
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16
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Lusk P. Emotion, ethics, epistemology: What can shame 'do' in medical education? J Eval Clin Pract 2023; 29:1135-1142. [PMID: 36317709 DOI: 10.1111/jep.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/22/2022] [Accepted: 10/04/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND Recent empirical studies have described and theorized a culture of shame within medical education in the Anglo-American context (Bynum). Shame is universal and highly social human emotion characterized by a sense of feeling objectified and judged negatively, in contrast to one's own self-concept. Shame has both an embodied and a relational dimension. Shame is considered especially relevant in healthcare settings (Dolezal and Lyons), and the tenets of patient care within the medical profession include respecting the dignity and upholding the safety of patients. However, shame is frequently deployed as a teaching tool within medical training. METHOD Here I ask, what can shame do in medical education (Ahmed)? What epistemic and relational conditions does it construct? I draw from philosophical voices in higher education to illuminate how shaming practices in medical education can undermine dignity safety (Callan), preclude inclusivity, and in the context of the hierarchical and marginalizing medical system, propagate epistemic injustice (Fricker). DISCUSSION This argument shows how shame in education can be both phenomenologically and normatively problematic and may act differently upon students who experience marginalization and those who are majoritized. I further suggest that a medical education system which upholds the epistemological and relational frameworks of power, shame, and epistemic injustice, underscores those frameworks in the medical system at large, disserving individual patients who are already at risk of suffering epistemic injustice (Carel), and society at large. CONCLUSION This analysis of shame in medical education focuses on the highly relational and interpersonal elements of learning to live and work in the medical system, highlighting the need for respect, trust, and resistance to reorient the relational learning environment toward individual and systemic forms of justice.
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Affiliation(s)
- Penelope Lusk
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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17
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Smith JF, Piemonte NM. The Problematic Persistence of Tiered Grading in Medical School. TEACHING AND LEARNING IN MEDICINE 2023; 35:467-476. [PMID: 35619232 DOI: 10.1080/10401334.2022.2074423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Issue: The evaluation of medical students is a critical, complex, and controversial process. It is tightly woven into the medical school curriculum, beginning at the inception of the medical student's professional journey. In this respect, medical student evaluation is among the first in a series of ongoing, lifelong assessments that influence the interpersonal, ethical, and socioeconomic dimensions necessary for an effective physician workforce. Yet, tiered grading has a questionable historic pedagogic basis in American medical education, and evidence suggests that tiered grading itself is a source of student burnout, anxiety, depression, increased competitiveness, reduced group cohesion, and racial biases. Evidence: In its most basic form, medical student evaluation is an assessment of the initial cognitive and technical competencies ultimately needed for the safe and effective practice of contemporary medicine. At many American medical schools, such evaluation relies largely on norm-based comparisons, such as tiered grading. Yet, tiered grading can cause student distress, is considered unfair by most students, is associated with biases against under-represented minorities, and demonstrates inconsistent correlation with residency performance. While arguments that tiered grading motivates student performance have enjoyed historic precedence in academia, such arguments are not supported by robust data or theories of motivation. Implications: Given the evolving recognition of the deleterious effects on medical student mental health, cohesiveness, and diversity, the use of tiered grading in medical schools to measure or stimulate academic performance, or by residency program directors to distinguish residency applicants, remains questionable. Examination of tiered grading in its historical, psychometric, psychosocial, and moral dimensions and the various arguments used to maintain it reveals a need for investigation of, if not transition to, alternative and non-tiered assessments of our medical students.
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Affiliation(s)
- James F Smith
- Departments of Medical Education and Medical Humanities, Creighton University, Omaha, Nebraska, USA
| | - Nicole M Piemonte
- Departments of Medical Humanities and Student Affairs, Creighton University, Phoenix, Arizona, USA
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18
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Babiker S, Ogunmwonyi I, Georgi MW, Tan L, Haque S, Mullins W, Singh P, Ang N, Fu H, Patel K, Khera J, Fricker M, Fleming S, Giwa-Brown L, A Brennan P, Irune E, Vig S, Nathan A. Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study. JMIR Res Protoc 2023; 12:e40545. [PMID: 37327055 DOI: 10.2196/40545] [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: 07/02/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. OBJECTIVE The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. METHODS This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. RESULTS Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. CONCLUSIONS Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40545.
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Affiliation(s)
| | | | - Maria W Georgi
- University College London Medical School, London, United Kingdom
| | | | - Sharmi Haque
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - William Mullins
- St Georges University Hospital National Health Service Trust, London, United Kingdom
| | - Prisca Singh
- University of Birmingham Medical School, Birmingham, United Kingdom
| | - Nadya Ang
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Howell Fu
- South West London Elective Orthopaedic Centre, London, United Kingdom
| | - Krunal Patel
- University College London Medical School, London, United Kingdom
| | - Jevan Khera
- University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | | | - Simon Fleming
- Institute of Health Sciences Education, Queen Mary University of London, London, United Kingdom
| | - Lolade Giwa-Brown
- Barts Health National Health Service Trust, Royal London Hospital, London, United Kingdom
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Ekpemi Irune
- Department of Otolaryngology, Head and Neck Surgery, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom
| | - Stella Vig
- Department of Vascular and General Surgery, Croydon University Hospital, London, United Kingdom
| | - Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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19
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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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Incongruous identities: Mental distress and burnout disparities in LGBTQ+ health care professional populations. Heliyon 2023; 9:e14835. [PMID: 37009240 PMCID: PMC10039783 DOI: 10.1016/j.heliyon.2023.e14835] [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: 02/15/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/28/2023] Open
Abstract
Health care professionals are chronically overworked due to structural workplace demands and institutional challenges [1]. During the COVID-19 pandemic, US biomedical health care professionals experienced additional environmental strain [2]. Health care professionals who occupy socio-politically minoritized identities are more likely to report symptoms of distress and workplace overburden than their counterparts [2]. While minority stress and identity formation theories explain the relationship between socially constructed identity and environmental strain, these theories remain largely unexplored in LGBTQ+ health care professional populations. Furthermore, contemporary investigations into health care professional burnout and mental distress fail to include differential impacts of identity-based stress, particularly within LGBTQ+ groups. This paper proposes a theoretical explanation for differential stress experiences by health care professionals and calls for research to investigate identity congruence as a key aspect of professionalization in medical schools. Health professions researchers need to attend to identity-based stress models to address discriminatory experiences with burnout and mental distress.
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21
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Jean DA, Jacobson CE, Rodriguez I, Vitous A, Kwakye G. The Hidden Burden: Qualitative Differences in How URiM Students Experience the Clinical Microenvironment. JOURNAL OF SURGICAL EDUCATION 2023; 80:372-384. [PMID: 36372726 DOI: 10.1016/j.jsurg.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION It is well documented that medical students who identify as underrepresented in medicine are more likely to encounter social challenges in the clinical environment. Successful navigation of these challenges requires a social and emotional agility that is unmeasured in traditional metrics of success. The effects of this requirement has not yet been explored. The authors therefore set out to investigate the variations in experiences that exist between underrepresented minority students in medicine (URiM) and white students, and to determine if there was a difference in the quantitative performance evaluations applied to both groups of students. METHODS This was a mixed-methods study. In the quantitative portion, the authors retrospectively analyzed the standardized patient encounter scores of medical students from a single medical school in Michigan during the years of 2016 to 2018. The authors used multivariable ordinary least squares regression models to evaluate the differences in scores by race. In the qualitative portion, students volunteered to be interviewed and self-identified their race and gender. The authors employed semi-structured interview techniques to gather information about how the student felt their cultural or ethnic background affected their experience in the clinical environment. RESULTS For the quantitative portion of this study, the authors analyzed the scores of 534 students over 4 different standardized patient encounters. The average score across all 4 standardized patient encounters was 88.7 (SD=5.6). The average score across all 4 standardized patient encounters for white students was 89 (SD=5.3), Black 87.9 (SD=7.4) Twenty-four students participated in the semi-structured interviews. Participants described feeling that the way their assessors interacted with them was largely affected by their race or gender. They also described feeling tension between how they would usually express themselves and how they were expected to in the clinical environment. When probed further, participants described various methods of adaptation to this tension including changing their hair or natural style of speech and modifying their perception of their role in the clinical environment.
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Affiliation(s)
| | - Clare E Jacobson
- Department of Surgery, University of Michigan Health System (Michigan Medicine), Ann Arbor, Michigan
| | | | - Ann Vitous
- Department of Surgery, University of Michigan Health System (Michigan Medicine), Ann Arbor, Michigan
| | - Gifty Kwakye
- Department of Colorectal Surgery, University of Michigan Health System (Michigan Medicine), Ann Arbor, Michigan.
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22
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Barriers and opportunities for promoting health professions careers among African American students in the Midwest. J Natl Med Assoc 2023; 115:101-118. [PMID: 36775786 DOI: 10.1016/j.jnma.2023.01.007] [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: 02/09/2022] [Revised: 07/28/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023]
Abstract
The purpose of our study is to examine the barriers and facilitators for urban African American students interested in pursuing health professions careers in the Midwest. In our analysis of the key informant interviews and focus groups, we identified four barriers (lack of preparation, lack of funding, lack of support/isolation, and perceived discrimination) and three facilitators (early preparation, support/mentorship, funding). We provide recommendations for how to leverage these facilitators and address the barriers to increase the representation of African Americans in the healthcare workforce. Novel future directions for this work should include comprehensive interventions tailored to URM students that span the health professions education pipeline and begin as early as elementary school. Interventions that engage mentors should take place at high school, undergraduate, and graduate health professions school levels.
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23
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Knight AP, Rea M, Allgood JA, Sciolla AF, Haywood A, Stephens MB, Rajasekaran S. Bringing Needed Change to Medical Student Well-Being: A Call to Expand Accreditation Requirements. TEACHING AND LEARNING IN MEDICINE 2023; 35:101-107. [PMID: 35085041 DOI: 10.1080/10401334.2021.2020121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Issue: Noting high rates of burnout, depression, and suicidality among medical students, academic medical communities are trying to identify preventive and curricular measures that protect and promote student well-being. To date, the effectiveness of these efforts is unclear. In addition, evidence increasingly suggests that the major drivers of distress appear to be factors within the social, learning, and work environments. Specific to medical schools in the United States, neither the Liaison Committee on Medical Education nor the Commission on Osteopathic College Accreditation include accreditation standards regarding well-being curricula and, as such, these curricula are not well-integrated into students' medical school experience. Current accreditation standards also do not specifically require institutions to assess or address systemic factors of the learning environment that negatively affect student well-being. Evidence: This paper proposes expanding current Liaison Committee on Medical Education and Commission on Osteopathic College Accreditation standards on professionalism to incorporate well-being as a core component of professional identity formation by requiring individual and institutional-level actions. Proposed changes to accreditation standards include (1) institutional assessment of the impact of the learning environment on student well-being; (2) continuous quality improvement efforts to address structural factors associated with student well-being and modification of practices that impair student well-being; and (3) integrated curriculum with related assessment to educate students on empirically-supported strategies for well-being. Implications: Refining undergraduate medical education accreditation standards in the United States to include language specific to student well-being will facilitate long overdue changes to the learning environment. In the end, the goal is not just to improve medical student well-being, but to provide a workforce better equipped for a sustainable and meaningful career.
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Affiliation(s)
- Allison P Knight
- Student Affairs, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Margaret Rea
- Student and Resident Wellness, University of California Davis School of Medicine, Sacramento, California, USA
| | - J Aaron Allgood
- Clinical Science Education and Department of Internal Medicine, A. T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona, USA
| | - Andres F Sciolla
- Department of Psychiatry, University of California Davis School of Medicine, Sacramento, California, USA
| | - Antwione Haywood
- Medical Student Education and Department of Clinical Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark B Stephens
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Senthil Rajasekaran
- Curricular Affairs and Undergraduate Medical Education, Wayne State University School of Medicine, Detroit, Michigan, USA
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Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
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Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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Konkwo C, Fitzsousa E, Chan SM, Muhammad M, Anderson N, Reisman A. Revisiting the Exhibits-Medical Student Reflections on Changes to the Institutional Portraiture at a US Medical School. J Gen Intern Med 2022; 37:4209-4215. [PMID: 36131052 PMCID: PMC9708960 DOI: 10.1007/s11606-022-07803-y] [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: 11/07/2021] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Yale School of Medicine's (YSM) Sterling Hall of Medicine (SHM) has historically been lined with large oil paintings of mostly White men, despite over a century of Black and female enrollment. These spaces can be seen as exclusionary to students underrepresented in medicine, and may result in decreased well-being and adversely affect academic performance. Student-led activism has resulted in recent changes to these walls, including the addition of images of women faculty, and artwork by students, faculty, and staff. OBJECTIVE We aimed to evaluate how recent changes to longstanding historical portraiture in SHM affected students' reflections on being in that space. DESIGN This was a qualitative study based on semi-structured interviews conducted virtually. PARTICIPANTS Second- to fourth-year YSM medical students were interviewed. APPROACH Qualitative interviews were used to gauge students' impressions of how they perceived both the original and updated artwork and portraiture, as well as the overall physical environment. KEY RESULTS Nine interviews were conducted, with interviewees describing the portraiture as reflective of YSM's institutional values. They related this to other aspects of an exclusionary environment, and noted that they created belonging at YSM within smaller communities. Students recognized and expressed appreciation for the changes to the portraiture, particularly the increase in diverse representation, and they noted stark contrasts to the prior space. While they describe positive attitudes regarding changes in SHM's exhibited portraiture and art, they also expressed skepticism about whether these changes were performative or whether they reflected true commitment to reform. CONCLUSIONS This study depicts how the portraiture and physical environment of a medical school affects medical students, and that interventions to reform institutional portraiture can have considerable impact on students' attitudes regarding their medical school experiences.
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Affiliation(s)
- Chigoziri Konkwo
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
| | - Elizabeth Fitzsousa
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shin Mei Chan
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | | | - Nientara Anderson
- Department of Psychiatry, Yale New Haven Hospital, New Haven, CT, USA
| | - Anna Reisman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Blalock AE, Leal DR. Redressing injustices: how women students enact agency in undergraduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:1-18. [PMID: 36394683 PMCID: PMC9672615 DOI: 10.1007/s10459-022-10183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.
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Affiliation(s)
- A Emiko Blalock
- Office of Medical Education Research and Development, Michigan State University College of Human Medicine, 964 Wilson Road, Fee Hall A214, East Lansing, MI, 48824, USA.
| | - Dianey R Leal
- Michigan State University College of Education, East Lansing, USA
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Konopasky AW, Bunin JL. Signaling Allyship: Preliminary Outcomes of a Faculty Curriculum to Support Minoritized Learners. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S132. [PMID: 37838865 DOI: 10.1097/acm.0000000000004865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Abigail W Konopasky
- Author affiliations: A.W. Konopasky, The Uniformed Services University of the Health Sciences and Henry M. Jackson Foundation for the Advancement of Military Medicine; J.L. Bunin, The Uniformed Services University of the Health Sciences
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Nguemeni Tiako MJ, Johnson S, Muhammad M, Osman NY, Solomon SR. Association Between Racial and Ethnic Diversity in Medical Specialties and Residency Application Rates. JAMA Netw Open 2022; 5:e2240817. [PMID: 36367730 PMCID: PMC9652751 DOI: 10.1001/jamanetworkopen.2022.40817] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE The lack of racial and ethnic diversity in the US medical profession is a well-recognized problem, and racial and ethnic representation is highly variable across the medical specialties. Residency selection is a crucial juncture at which diversity and representation in specialties can be increased. OBJECTIVE To identify factors associated with residency application rates for medical specialties by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This national cross-sectional study of medical student residency applications used American Association of Medical Colleges data on 2019-2020 applicants and information about the racial and ethnic characteristics of practicing physicians (including medical school faculty) and department chairs. A total of 26 320 applicants to medical residency programs, 592 296 practicing physicians, and 2121 department chairs across the US were included. Residency application rates for 18 medical specialties were evaluated. MAIN OUTCOMES AND MEASURES The main outcome was the specialty representation quotient (SRQ), which estimated the extent to which students from a racial or ethnic group were overrepresented (an SRQ >1) or underrepresented (an SRQ <1) in a given specialty compared with the racial and ethnic demographic characteristics of the corresponding graduating class. Covariates included the racial and ethnic demographic characteristics of practicing physicians and department chairs by specialty based on American Association of Medical Colleges data and student academic factors (mean United States Medical Licensing Examination step 1 score, number of research experiences, and AΩA honor society membership among matched students from the previous application cycle). Multivariable logistic regression analysis was used to examine associations between these covariates and application rates by race and ethnicity. RESULTS Among 26 320 specialty-specific applications to medical residency programs in 18 specialties, 90 (0.3%) were from American Indian or Alaska Native students, 6718 (25.5%) were from Asian students, 2575 (9.8%) were from Black students, 1896 (7.2%) were from Hispanic students, and 15 041 (57.1%) were from White students. Among 592 296 practicing physicians, 2777 (0.5%) were American Indian or Alaska Native, 117 358 (19.8%) were Asian, 36 639 (6.2%) were Black, 41 071 (6.9%) were Hispanic, and 394 451 (66.6%) were White. Among 2121 department chairs, 5 (0.2%) were American Indian or Alaska Native, 212 (10.0%) were Asian, 86 (4.1%) were Black, 88 (4.1%) were Hispanic, and 1730 (81.6%) were White. The specialties with the greatest representation among applicants from racial and ethnic groups underrepresented in medicine (URM) were family medicine (SRQ, 1.70), physical medicine and rehabilitation (SRQ, 1.60), and obstetrics and gynecology (SRQ, 1.47). The specialties with the lowest URM representation among applicants were plastic surgery (SRQ, 0.47), otolaryngology (SRQ, 0.53), and orthopedic surgery (SRQ, 0.86). Membership in AΩA was negatively associated with SRQ among American Indian or Alaska Native students only (β = -0.11; 95% CI, -0.17 to -0.05; P = .002). Racial and ethnic representation among practicing physicians was positively associated with SRQ for American Indian or Alaska Native students (β = 6.05; 95% CI, 4.26-7.85; P < .001), Asian students (β = 0.07; 95% CI, 0.06-0.09; P < .001), Black students (β = 0.10; 95% CI, 0.06-0.15; P < .001), and URM students overall (β = 0.05; 95% CI, 0.01-0.08; P = .02). CONCLUSIONS AND RELEVANCE This study's findings suggest that the propensity of medical students, particularly those from racial and ethnic minority groups, to apply to a given specialty for residency was associated with the representation of their racial or ethnic group among the specialty's practicing physicians. Future work to characterize the mechanisms of occupational sorting may guide interventions to improve equity within the physician workforce.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Shawn Johnson
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Nora Y. Osman
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sonja R. Solomon
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Drake C, Lewis CF, Lekas HM. Reckoning with Racism in the Match Process. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:663-666. [PMID: 35768748 PMCID: PMC9243903 DOI: 10.1007/s40596-022-01669-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/31/2022] [Indexed: 05/05/2023]
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Mathieu J, Fotsing S, Akinbobola K, Shipeolu L, Crosse K, Thomas K, Denis-LeBlanc M, Gueye A, Bekolo G. The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students. CMAJ Open 2022; 10:E937-E944. [PMID: 36280249 PMCID: PMC9640166 DOI: 10.9778/cmajo.20220192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Black medical students have been consistently underrepresented in Canadian medical schools, and data on the impact of discrimination on their medical education remain limited. In this cross-sectional study, we aimed to investigate the experiences of Black medical students through the Black Medical Students' Association of Canada (BMSAC). METHODS We developed a 63-item instrument around the domains of inclusion and diversity, wellness, discrimination, career advancement and diversity in medical education. The anonymous web-based questionnaire was sent to 128 medical students and first-year residents from all 17 Canadian medical schools via the BMSAC listserv. We obtained frequencies for demographic data and self-reported experiences. RESULTS We received 52 responses. Of respondents, 59% had at least 1 personal encounter with discrimination in medical school. Discrimination was experienced in both clinical and academic contexts, notably from patients, peers and hospital staff. Students further along in their medical training were more likely to endorse having experienced discrimination in medical school. Most respondents had positive experiences with academic and clinical inclusion, as well as resiliency in the face of discrimination. However, most respondents had negative experiences relating to reporting discrimination, their well-being, career advancement, sentiments of minority tax and low diversity in medical education. INTERPRETATION We found that discrimination has important implications on the learning experiences of Black medical students surveyed from the BMSAC. This directly challenges the notion that Canadian medical schools are impervious to racism and highlights the need for advocacy and systemic changes to eliminate institutional racism.
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Affiliation(s)
- Johanne Mathieu
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont.
| | - Salomon Fotsing
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kikelomo Akinbobola
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Lolade Shipeolu
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kien Crosse
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kimberley Thomas
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Manon Denis-LeBlanc
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Abdoulaye Gueye
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Gaelle Bekolo
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont.
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Nguyen M, Chaudhry SI, Desai MM, Chen C, Mason HRC, McDade WA, Fancher TL, Boatright D. Association of Sociodemographic Characteristics With US Medical Student Attrition. JAMA Intern Med 2022; 182:917-924. [PMID: 35816334 PMCID: PMC9274446 DOI: 10.1001/jamainternmed.2022.2194] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Diversity in the medical workforce is critical to improve health care access and achieve equity for resource-limited communities. Despite increased efforts to recruit diverse medical trainees, there remains a large chasm between the racial and ethnic and socioeconomic composition of the patient population and that of the physician workforce. Objective To analyze student attrition from medical school by sociodemographic identities. Design, Setting, and Participants This retrospective cohort study included allopathic doctor of medicine (MD)-only US medical school matriculants in academic years 2014-2015 and 2015-2016. The analysis was performed from July to September 2021. Main Outcomes and Measures The main outcome was attrition, defined as withdrawal or dismissal from medical school for any reason. Attrition rate was explored across 3 self-reported marginalized identities: underrepresented in medicine (URiM) race and ethnicity, low income, and underresourced neighborhood status. Logistic regression was assessed for each marginalized identity and intersections across the 3 identities. Results Among 33 389 allopathic MD-only medical school matriculants (51.8% male), 938 (2.8%) experienced attrition from medical school within 5 years. Compared with non-Hispanic White students (423 of 18 213 [2.3%]), those without low income (593 of 25 205 [2.3%]), and those who did not grow up in an underresourced neighborhood (661 of 27 487 [2.4%]), students who were URiM (Hispanic [110 of 2096 (5.2%); adjusted odds ratio (aOR), 1.41; 95% CI, 1.13-1.77], non-Hispanic American Indian/Alaska Native/Native Hawaiian/Pacific Islander [13 of 118 (11.0%); aOR, 3.20; 95% CI, 1.76-5.80], and non-Hispanic Black/African American [120 of 2104 (5.7%); aOR, 1.41; 95% CI, 1.13-1.77]), those who had low income (345 of 8184 [4.2%]; aOR, 1.33; 95% CI, 1.15-1.54), and those from an underresourced neighborhood (277 of 5902 [4.6%]; aOR, 1.35; 95% CI, 1.16-1.58) were more likely to experience attrition from medical school. The rate of attrition from medical school was greatest among students with all 3 marginalized identities (ie, URiM, low income, and from an underresourced neighborhood), with an attrition rate 3.7 times higher than that among students who were not URiM, did not have low income, and were not from an underresourced neighborhood (7.3% [79 of 1086] vs 1.9% [397 of 20 353]; P < .001). Conclusions and Relevance This retrospective cohort study demonstrated a significant association of medical student attrition with individual (race and ethnicity and family income) and structural (growing up in an underresourced neighborhood) measures of marginalization. The findings highlight a need to retain students from marginalized groups in medical school.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M. Desai
- Chronic Disease Epidemiology Department, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Candice Chen
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - William A. McDade
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Tonya L. Fancher
- Division of General Internal Medicine, Geriatrics and Bioethics, University of California, Davis, School of Medicine, Sacramento
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Klein R, Ufere NN, Schaeffer S, Julian KA, Rao SR, Koch J, Volerman A, Snyder ED, Thompson V, Ganguli I, Burnett-Bowie SAM, Palamara K. Association Between Resident Race and Ethnicity and Clinical Performance Assessment Scores in Graduate Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1351-1359. [PMID: 35583954 PMCID: PMC9910786 DOI: 10.1097/acm.0000000000004743] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE To assess the association between internal medicine (IM) residents' race/ethnicity and clinical performance assessments. METHOD The authors conducted a cross-sectional analysis of clinical performance assessment scores at 6 U.S. IM residency programs from 2016 to 2017. Residents underrepresented in medicine (URiM) were identified using self-reported race/ethnicity. Standardized scores were calculated for Accreditation Council for Graduate Medical Education core competencies. Cross-classified mixed-effects regression assessed the association between race/ethnicity and competency scores, adjusting for rotation time of year and setting; resident gender, postgraduate year, and IM In-Training Examination percentile rank; and faculty gender, rank, and specialty. RESULTS Data included 3,600 evaluations by 605 faculty of 703 residents, including 94 (13.4%) URiM residents. Resident race/ethnicity was associated with competency scores, with lower scores for URiM residents (difference in adjusted standardized scores between URiM and non-URiM residents, mean [standard error]) in medical knowledge (-0.123 [0.05], P = .021), systems-based practice (-0.179 [0.05], P = .005), practice-based learning and improvement (-0.112 [0.05], P = .032), professionalism (-0.116 [0.06], P = .036), and interpersonal and communication skills (-0.113 [0.06], P = .044). Translating this to a 1 to 5 scale in 0.5 increments, URiM resident ratings were 0.07 to 0.12 points lower than non-URiM resident ratings in these 5 competencies. The interaction with faculty gender was notable in professionalism (difference between URiM and non-URiM for men faculty -0.199 [0.06] vs women faculty -0.014 [0.07], P = .01) with men more than women faculty rating URiM residents lower than non-URiM residents. Using the 1 to 5 scale, men faculty rated URiM residents 0.13 points lower than non-URiM residents in professionalism. CONCLUSIONS Resident race/ethnicity was associated with assessment scores to the disadvantage of URiM residents. This may reflect bias in faculty assessment, effects of a noninclusive learning environment, or structural inequities in assessment.
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Affiliation(s)
- Robin Klein
- R. Klein is associate professor, Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nneka N Ufere
- N.N. Ufere is instructor of medicine, Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Schaeffer
- S. Schaeffer is associate professor, Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine A Julian
- K.A. Julian is professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Sowmya R Rao
- S.R. Rao is statistician, Department of Global Health, Boston University School of Public Health and Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts
| | - Jennifer Koch
- J. Koch is professor, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Anna Volerman
- A. Volerman is associate professor, Departments of Medicine and Pediatrics, University of Chicago, Chicago, Illinois
| | - Erin D Snyder
- E.D. Snyder is professor, Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, Alabama
| | - Vanessa Thompson
- V. Thompson is associate professor, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Ishani Ganguli
- I. Ganguli is assistant professor, Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sherri-Ann M Burnett-Bowie
- S.-A.M. Burnett-Bowie is assistant professor, Department of Medicine, Division of Endocrinology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kerri Palamara
- K. Palamara is associate professor, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Poon SC, Nellans K, Gorroochurn P, Chahine NO. Race, But Not Gender, Is Associated With Admissions Into Orthopaedic Residency Programs. Clin Orthop Relat Res 2022; 480:1441-1449. [PMID: 33229901 PMCID: PMC9278929 DOI: 10.1097/corr.0000000000001553] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/09/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic surgery is one of the most competitive but least diverse surgical specialties, with ever-increasing academic achievements (such as test scores) shown by applicants. Prior research shows that white applicants had higher United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge scores as well as higher odds of Alpha Omega Alpha status compared with Black, Hispanic, and other applicant groups. Yet, it still remains unknown whether differences in application metrics by race/ethnicity sufficiently explain the underrepresentation of certain racial or ethnic minority groups in orthopaedic residency programs. QUESTIONS/PURPOSES In this study, we sought to determine (1) the relative weight of academic variables for admission into orthopaedic residency, and (2) whether race and gender are independently associated with admission into an orthopedic residency. METHODS The Electronic Residency Application System (ERAS) data from the Association of American Medical Colleges (AAMC) and the National Board of Medical Examiners (NBME) of first-time MD applicants (n = 8966) for orthopaedic surgery residency positions in the United States and of admitted orthopaedic residents (n = 6218) from 2005 to 2014 were reviewed. This dataset is the first and most comprehensive of its kind to date in orthopaedic surgery. Academic metrics, such as USMLE Step 1 and Step 2 Clinical Knowledge scores, number of publications, Alpha Omega Alpha status, volunteer experiences, work experience, as well as race and gender, were analyzed using hierarchical logistic regression models. The first model analyzed the association of academic metrics with admission into orthopaedic residency. In the second model, we added race and gender and controlled for metrics of academic performance. To determine how well the models simulated the actual admissions data, we computed the receiver operating characteristics (ROC) including the area under curve (AUC), which measures the model's ability to simulate which applicants were admitted or not admitted, with an AUC = 1.0 representing a perfect simulation. The odds ratio and confidence interval of each variable were computed. RESULTS When only academic variables were analyzed in the first model, Alpha Omega Alpha status (odds ratio 2.12 [95% CI 1.80 to 2.50]; p < 0.001), the USMLE Step 1 score (OR 1.04 [95% CI 1.03 to 1.04]; p < 0.001), the USMLE Step 2 Clinical Knowledge score (OR 1.01 [95% CI 1.01 to 1.02]; p < 0.001), publication count (OR 1.04 [95% CI 1.03 to 1.05]; p < 0.001), and volunteer experience (OR 1.03 [95% CI 1.01 to 1.04]; p < 0.001) were associated with admissions into orthopaedics while work and research experience were not. This model yielded a good prediction of the results with an AUC of 0.755. The second model, in which the variables of race and gender were added to the academic variables, also had a good prediction of the results with an AUC of 0.759. This model indicates that applicant race, but not gender, is associated with admissions into orthopaedic residency. Applicants from Asian (OR 0.78 [95% CI 0.67 to 0.92]), Black (OR 0.63 [95% CI 0.51 to 0.77], Hispanic (OR 0.48 [95% CI 0.36 to 0.65]), or other race groups (OR 0.65 [95% CI 0.55 to 0.77]) had lower odds of admission into residency compared with white applicants. CONCLUSION Minority applicants, but not women, have lower odds of admission into orthopaedic surgery residency, even when accounting for academic performance metrics. Changes in the residency selection processes are needed to eliminate the lower admission probability of qualified minority applicants in orthopaedic residency and to improve the diversity and inclusion of orthopaedic surgery. Changes including increasing the diversity of the selection committee, bias training, blinding applications before review, removal of metrics with history of racial disparities from an interviewer's candidate profile before an interview, and use of holistic application review (where an applicants' experiences, attributes, and academic metrics are all considered) can improve the diversity landscape in training. In addition, cultivating an environment of inclusion will be necessary to address these long-standing trends in orthopaedic surgery. CLINICAL RELEVANCE Race, but not gender, is associated with the odds of acceptance into orthopaedic surgery residency despite equivalent academic metrics. Changes in residency selection processes are suggested to eliminate the lower admission probability of qualified minority applicants into orthopaedic residency and to improve the diversity and inclusion of orthopaedic surgery.
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Affiliation(s)
- Selina C Poon
- Orthopaedic Surgery Department, Shriners for Children Medical Center at Pasadena, Pasadena, CA, USA
| | - Kate Nellans
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY, USA
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Nguemeni Tiako MJ, Ray V, South EC. Medical Schools as Racialized Organizations: How Race-Neutral Structures Sustain Racial Inequality in Medical Education-a Narrative Review. J Gen Intern Med 2022; 37:2259-2266. [PMID: 35710658 PMCID: PMC9202970 DOI: 10.1007/s11606-022-07500-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
In 2021, The American Association of Medical Colleges released a framework addressing structural racism in academic medicine, following the significant, nationwide Movement for Black Lives. The first step of this framework is to "begin self-reflection and educating ourselves." Indeed, ample evidence shows that medical schools have a long history of racially exclusionary practices. Drawing on racialized organizations theory from the field of sociology, we compile and examine scholarship on the role of race and racism in medical training, focusing on disparities in educational and career outcomes, experiences along racial lines in medical training, and long-term implications. From the entrance into medical school through the residency application process, organizational factors such as reliance on standardized tests to predict future success, a hostile learning climate, and racially biased performance metrics negatively impact the careers of trainees of color, particularly those underrepresented in medicine (URiM). Indeed, in addition to structural biases associated with otherwise "objective" metrics, there are racial disparities across subjective outcomes such as the language used in medical trainees' performance evaluations, even when adjusting for grades and board exam scores. These disadvantages contribute to URIM trainees' lower odds of matching, steering into less competitive and lucrative specialties, and burnout and attrition from academic careers. Additionally, hostile racial climates and less diverse medical schools negatively influence White trainees' interest in practicing in underserved communities, disproportionally racial and ethnic minorities. Trainees' mental health suffers along the way, as do medical schools' recruitment, retention, diversity, and inclusion efforts. Evidence shows that seemingly race-neutral processes and structures within medical education, in conjunction with individuals' biases and interpersonal discrimination, may reproduce and sustain racial inequality among medical trainees. Medical schools whose goals include training a more diverse physician workforce towards addressing racial health disparities require a new playbook.
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Affiliation(s)
- Max Jordan Nguemeni Tiako
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Urban Health Lab, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Victor Ray
- Department of Sociology, University of Iowa, Iowa City, IA, USA
| | - Eugenia C South
- Urban Health Lab, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Sharp S, Hixson A, Stumpff J, Williamson F. Understanding the Experiences of Black Women Medical Students and Residents: A Narrative Review. Front Public Health 2022; 10:879135. [PMID: 35774571 PMCID: PMC9237355 DOI: 10.3389/fpubh.2022.879135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few research studies examine medical students and residents with intersectional identities. In the emerging literature, data on Black women's experiences may be misrepresented and misinterpreted as studies aggregate data for women, students of color, and Black/African American men. As such, these studies do not account for the nuanced experiences of gendered racism that Black women students and residents may encounter during their medical education. Methods Using Crenshaw's intersectionality as an analytical tool, we conducted a narrative review to highlight how Black women medical students and residents are rendered invisible in the current literature on medical education. Results The results generated 13 citations specifically discussing Black women medical students and residents, with only six studies being empirical research. Conclusion We conclude that 13 articles is inadequate for understanding the experiences of these populations. Without centering Black women or using an intersectional lens, researchers could invalidate the lived experiences of this population and create barriers to the political resources Black women learners need to be successful. Moreover, the lack of intention behind addressing the needs of Black women can be viewed as complicity in the oppressive structures that serve to subjugate them.
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Affiliation(s)
- Sacha Sharp
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Sacha Sharp ; orcid.org/0000-0002-1532-4783
| | - Ashley Hixson
- College of Education, University of Maryland, College Park, MD, United States
| | - Julia Stumpff
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Francesca Williamson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, 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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Sukhera J, Goez H, Brown A, Haddara W, Razack S. Freedom from discrimination or freedom to discriminate? Discursive tensions within discrimination policies in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:387-403. [PMID: 35025019 PMCID: PMC8757400 DOI: 10.1007/s10459-022-10090-1] [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: 04/23/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
The importance of advancing equity, diversity, and inclusion for all members of the academic medical community has gained recent attention. Academic medical organizations have attempted to increase broader representation while seeking structural reforms consistent with the goal of enhancing equity and reducing disproportionality. However, efforts remain constrained while minority groups continue to experience discrimination. In this study, the authors sought to identify and understand the discursive effects of discrimination policies within medical education. The authors assembled an archive of 22 texts consisting of publicly available discrimination and harassment policy documents in 13 Canadian medical schools that were active as of November 2019. Each text was analysed to identify themes, rhetorical strategies, problematization, and power relations. Policies described truth statements that appear to idealize equity, yet there were discourses related to professionalism and neutrality that were in tension with these ideals. There was also tension between organizations' framing of a shared responsibility for addressing discrimination and individual responsibility on complainants. Lastly, there were also competing discourses on promoting freedom from discrimination and the concept of academic freedom. Overall, findings reveal several areas of tension that shape how discrimination is addressed in policy versus practice. Existing discourses regarding self-protection and academic freedom suggest equity cannot be advanced through policy discourse alone and more substantive structural transformation may be necessary. Existing approaches may be inadequate to address discrimination unless academic medical organizations interrogate the source of these discursive tensions and consider asymmetries of power.
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Affiliation(s)
- Javeed Sukhera
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA.
| | - Helly Goez
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences University of Alberta, Edmonton, Canada
| | - Allison Brown
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Wael Haddara
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Saleem Razack
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Paediatrics and Institute for Health Sciences Education, McGill University, Montreal, Canada
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Crawford BA, Hillier A. Assessing the experience of dental students with an asynchronous online course about racism, cultural competence. J Dent Educ 2022; 86:1359-1368. [PMID: 35470902 DOI: 10.1002/jdd.12943] [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: 01/15/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE University of Pennsylvania School of Dental Medicine and the University of Pennsylvania School of Social Policy and Practice (SP2) designed an asynchronous online course about racism and cultural competence to address student concerns about harmful interactions with peers across race/ethnicity. The Penn Experience Course establishes common language and concepts to facilitate difficult conversations about racism in the classroom and clinical spaces. METHODS The course included six modules addressing the history of racism in the Philadelphia area and at the University of Pennsylvania: implicit bias and microaggressions; racism and other forms of oppression; gender identity and sexuality; construction of whiteness and white supremacy ideology; cultural humility, disparities, and equity; and access in healthcare. Students completed pre- and post-course surveys about their likelihood of engaging with the neighborhood surrounding Penn, confidence discussing the topics covered, and general experience with the course. RESULTS Four hundred forty-nine students completed post-course surveys, 220 of which could be linked to precourse survey responses. Overwhelmingly, students reported a positive experience with the course, an increase in their likelihood to engage with the Penn neighborhood, and increased confidence in discussing course topics with peers. Many students suggested incorporating synchronous discussion, while a smaller group expressed resentment about the focus on whiteness, white fragility, and anti-Black racism. Several students of color expressed concern that the course centered the learning needs of white students. CONCLUSION Asynchronous online content offers an effective and efficient way of teaching dental students about the basics of cultural competence. Educators should anticipate resistance from some white students and the distinct learning needs of students of color.
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Affiliation(s)
- Beverley A Crawford
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Amy Hillier
- University of Pennsylvania School of Social Policy and Practice, Philadelphia, Pennsylvania, USA
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Kristoffersson E, Hamberg K. "I have to do twice as well" - managing everyday racism in a Swedish medical school. BMC MEDICAL EDUCATION 2022; 22:235. [PMID: 35365131 PMCID: PMC8973650 DOI: 10.1186/s12909-022-03262-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/11/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Mounting evidence suggests that medical students from cultural/ethnic minority backgrounds face recurring and more or less subtle racist oppression, i.e., everyday racism. Insights into how they handle these inequalities, though, are scarce - especially in a Swedish context. In this interview study we therefore explored and analyzed the strategies used by racialized minority medical students to manage episodes of everyday racism - and their underlying motives and considerations. METHODS Individual interviews were carried out with 15 medical students (8 women, 7 men) who self-identified as having ethnic- or cultural minority backgrounds. Inspired by constructivist grounded theory, data were collected and analyzed simultaneously. RESULTS Participants strove to retain their sense of self as active students and professional future physicians - as opposed to passive and problematic 'Others'. Based on this endeavor, they tried to manage the threat of constraining stereotypes and exclusion. Due to the power relations in medical education and clinical placement settings as well as racialized students' experience of lacking both credibility and support from bystanders, few dared to speak up or report negative treatment. Instead, they sought to avoid racism by withdrawing socially and seeking safe spaces. Or, they attempted to adopt a professional persona that was resistant to racial slights. Lastly, they tried to demonstrate their capability or conform to the majority culture, in attempts to refute stereotypes. CONCLUSIONS Racism is not caused by the exposed individuals' own ways of being or acting. Therefore, behavioral changes on the part of minority students will not relieve them from discrimination. Rather, strategies such as adaptation and avoidance run the risk of re-inscribing the white majority as the norm for a medical student. However, as long as racialized minority students stand alone it is difficult for them to act in any other way. To dismantle racism in medical education, this study indicates that anti-racist policies and routines for handling discrimination are insufficient. School management should also acknowledge racially minoritized students' experiences and insights about racist practices, provide students and supervisors with a structural account of racism, as well as organize training in possible ways to act as a bystander to support victims of racism, and create a safer working environment for all.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden.
- Umeå Centre for Gender Studies, Umeå University, 901 87, Umeå, Sweden.
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden
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Forrest D, George S, Stewart V, Dutta N, McConville K, Pope L, Kumar S. Cultural diversity and inclusion in UK medical schools. CLINICAL TEACHER 2022; 19:213-220. [PMID: 35243769 PMCID: PMC9313838 DOI: 10.1111/tct.13472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
Background Racially minoritised groups across the globe continue to experience differential outcomes in both health and education. Medical schools can play an instrumental role in addressing both these disparities, by creating inclusive student communities and ensuring that tomorrow's doctors can care for our increasingly diverse populations. Objectives This collaborative, qualitative study led by three United Kingdom (UK) institutions aimed to explore the perspectives of Heads of Primary Care Teaching (HOTs) on cultural diversity and inclusion across UK medical schools. Methods In December 2020, five focus groups were conducted remotely with 23 HOTs, or a nominated deputy. We explored participants' opinions regarding opportunities and barriers to cultural diversity and inclusion in medical education, ways to overcome these challenges and shared examples of best practice. Data were transcribed verbatim and thematically analysed by three researchers. Results Investigators identified six themes from the data: lack of faculty diversity, tokenistic faculty training, institutional mindset, diversifying the formal and hidden curricula, intersectionality and student voice. Conclusion Medical schools worldwide face similar challenges, uncertainties and opportunities when integrating diversity and inclusion throughout the learning environment. Although the importance of the topic is increasingly acknowledged, current efforts are viewed as being passive and tokenistic, hindered by challenges at multiple levels. Partnership with students and collaboration within and between institutions nationally and internationally will enable us to move forwards with both local and global positive, sustainable change.
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Affiliation(s)
- Dominique Forrest
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | | | - Nina Dutta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | | | - Sonia Kumar
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Neville P. When I say … everyday racism. MEDICAL EDUCATION 2022; 56:260-261. [PMID: 34545603 DOI: 10.1111/medu.14667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
In this 'When I say …' article, the concept of everyday racism is defined and explained as a useful theoretical and methodological tool to evidence the numerous ways in which the climate of medical school can adversely impact the social and educational achievements of ethnic minority students.
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VanderMeulen S, Snyder JA, Kohlhepp W, Mustone Alexander L, Straker H, Bowser J, Bondy MJ. Pipeline to the Physician Assistant Profession: A Look to the Future. J Physician Assist Educ 2022; 33:e1-e10. [PMID: 35170559 DOI: 10.1097/jpa.0000000000000414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The current pipeline of physician assistant (PA) school applicants reflects the future workforce of the profession, which is why the admissions process with all its components and variables is so important. Many studies have shown that a workforce that represents the patients it cares for leads to improved health outcomes, especially among underrepresented minority populations. Yet, PA programs have made little progress over the past 2 decades in increasing the diversity of matriculants and graduates. As a profession, it is our collective responsibility to intentionally advance diversity, equity, and inclusion, and examining the admissions process would be the most logical place to start.
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Affiliation(s)
- Stephane VanderMeulen
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
| | - Jennifer A Snyder
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
| | - William Kohlhepp
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
| | - Lisa Mustone Alexander
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
| | - Howard Straker
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
| | - Jonathan Bowser
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
| | - Mary Jo Bondy
- Stephane VanderMeulen, MPAS, PA-C , is an associate professor and the program director for the Physician Assistant Program, Creighton University School of Medicine in Omaha, Nebraska
- Jennifer A. Snyder, PhD, PA-C , is a professor and associate dean for the College of Pharmacy and Health Sciences at Butler University in Indianapolis, Indiana
- William Kohlhepp, DHSc, MHA, PA-C , is a professor emeritus of Physician Assistant Studies at Quinnipiac University in Hamden, Connecticut
- Lisa Mustone Alexander, EdD, MPH, PA-C , is a professor and the director of the Physician Associate Programme at the Royal College of Surgeons in Ireland (RCSI) in Dublin, Ireland
- Howard Straker, EdD, MPH, PA-C , is an assistant professor and director of the PA/MPH program at the George Washington University School of Medicine and Health Sciences in Washington, DC
- Jonathan Bowser, MS, PA-C , is an associate dean and the program director for the Child Health Associate/ Physician Assistant Program at the University of Colorado in Aurora, Colorado
- Mary Jo Bondy, DHEd, MHS, PA-C , is the chief executive officer for the Physician Assistant Education Association in Washington, DC
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Ellis R, Brennan PA, Lee AJ, Scrimgeour DS, Cleland J. Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: a retrospective cohort study. J R Soc Med 2022; 115:257-272. [PMID: 35171739 PMCID: PMC9234885 DOI: 10.1177/01410768221079018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective A recent independent review on diversity and inclusivity highlighted concerns
that barriers to surgical career progression exist for some groups of
individuals and not others. Group-level differences in performance at the
Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS)
examinations have been identified but are yet to be investigated. We aimed
to characterise the relationship between sociodemographic differences and
performance at MRCS. Design Retrospective cohort study. Setting Secondary care. Participants All UK MRCS candidates attempting Part A (n = 5780) and Part
B (n = 2600) between 2013 and 2019 with linked
sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk). Main outcome measures Chi-square tests established univariate associations with MRCS performance.
Multiple logistic regression identified independent predictors of success,
adjusted for medical school performance. Results Statistically significant differences in MRCS pass rates were found according
to gender, ethnicity, age, graduate status, educational background and
socioeconomic status (all p < 0.05). After adjusting for
prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence
interval [CI] 1.87–2.92) or a non-graduate (OR 1.98, 95% CI 1.44–2.74) were
independent predictors of MRCS Part A success and being a non-graduate (OR
1.77, 95% CI 1.15–2.71) and having attended a fee-paying school (OR 1.51,
95% CI 1.08–2.10) were independent predictors of Part B success. Black and
minority ethnic groups were significantly less likely to pass MRCS Part B at
their first attempt (OR 0.41, 95% CI 0.18–0.92 for Black candidates and OR
0.49, 95% CI 0.35–0.69 for Asian candidates) compared to White
candidates. Conclusions There is significant group-level differential attainment at MRCS, likely to
represent the accumulation of privilege and disadvantage experienced by
individuals throughout their education and training. Those leading surgical
education now have a responsibility to identify and address the causes of
these attainment differences.
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Affiliation(s)
- Ricky Ellis
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK.,Urology Department, Nottingham University Hospitals, Nottingham, NG5 1PB, UK
| | - Peter A Brennan
- Department of Maxillo-Facial Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, AB24 3FX, UK
| | - Duncan Sg Scrimgeour
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK.,Department of Colorectal Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore
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Muldoon KM. IMPROVing communication about diversity, equity, and inclusion in health professions education. Anat Rec (Hoboken) 2022; 305:1000-1018. [PMID: 35103421 DOI: 10.1002/ar.24864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called "Humanity in Medicine." Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.
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Affiliation(s)
- Kathleen M Muldoon
- Department of Anatomy, College of Graduate Studies and Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
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van Andel CEE, Born MP, van den Broek WW, Stegers‐Jager KM. Student ethnicity predicts social learning experiences, self-regulatory focus and grades. MEDICAL EDUCATION 2022; 56:211-219. [PMID: 34543459 PMCID: PMC9293402 DOI: 10.1111/medu.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 06/03/2023]
Abstract
CONTEXT Ethnic minority students find that their ethnicity negatively affects the evaluation of their capacities and their feelings in medical school. This study tests whether ethnic minority and majority students differ in their 'self-regulatory focus' in clinical training, that is, their ways to approach goals, due to differences in social learning experiences. Self-regulatory focus consists of a promotion and prevention focus. People who are prone to stereotypes and unfair treatments are more likely to have a prevention focus and conceal certain identity aspects. The objectives of the study are to test whether ethnic minority students, as compared with ethnic majority students, are equally likely to have a promotion focus, but more likely to have a prevention focus in clinical training due to more negative social learning experiences (Hypothesis 1), and whether the relationship between student ethnicity and clinical evaluations can be explained by students' gender, social learning experiences, self-regulatory focus and impression management (Hypothesis 2). METHODS Survey and clinical evaluation data of 312 (71.2% female) clerks were collected and grouped into 215 ethnic majority (69.4%) and 95 ethnic minority students (30.6%). Students' social learning experiences were measured as perceptions of unfair treatment, trust in supervisors and social academic fit. Self-regulatory focus (general and work specific) and impression management were also measured. A parallel mediation model (Hypothesis 1) and hierarchical multiple regression analyses were used (Hypothesis 2). RESULTS Ethnic minority students had higher perceptions of unfair treatment and lower trust in their supervisors in clinical training. They were more prevention focused in clinical training, but this was not mediated by having more negative social learning experiences. Lower clinical evaluations for ethnic minority students were unexplained. Promotion focus in clinical training and trust in supervisors positively relate to clinical grades. CONCLUSION Student ethnicity predicts social learning experiences, self-regulatory focus and grades in clinical training. The hidden curriculum plausibly plays a role here.
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Affiliation(s)
| | - Marise P. Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
- Optentia and Faculty of Economic and Management SciencesNorth‐West UniversityPotchefstroomSouth Africa
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Anderson N, Lett E, Asabor EN, Hernandez AL, Nguemeni Tiako MJ, Johnson C, Montenegro RE, Rizzo TM, Latimore D, Nunez-Smith M, Boatright D. The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students. J Gen Intern Med 2022; 37:298-307. [PMID: 33939079 PMCID: PMC8811096 DOI: 10.1007/s11606-021-06786-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS We conducted a cross-sectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1.48-11.05), and 9.38 (95% CI: 3.71-26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.
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Affiliation(s)
- Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Elle Lett
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | - Tara M Rizzo
- Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Marcella Nunez-Smith
- Department of Internal Medicine and the Equity Research and Innovation Center (ERIC), Yale School of Medicine, New Haven, CT, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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O’Marr JM, Chan SM, Crawford L, Wong AH, Samuels E, Boatright D. Perceptions on Burnout and the Medical School Learning Environment of Medical Students Who Are Underrepresented in Medicine. JAMA Netw Open 2022; 5:e220115. [PMID: 35195698 PMCID: PMC8867243 DOI: 10.1001/jamanetworkopen.2022.0115] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
IMPORTANCE Burnout is a highly prevalent issue among medical trainees, but there has been limited research characterizing burnout specifically among medical students from groups who are underrepresented in medicine (URIM). OBJECTIVE To assess the association between components of the medical school learning environment and burnout among medical students who are URIM vs those who are not. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional survey study evaluated responses of allopathic medical students graduating from all US allopathic medical schools in 2016 and 2017 to the American Medical Colleges Graduation Questionnaire. Analysis was completed between December 1, 2019, and July 1, 2020. EXPOSURES Self-identification as a medical student who is URIM. MAIN OUTCOMES AND MEASURES Self-reported measures of medical student overall, disengagement, and exhaustion-related burnout using the Oldenburg Burnout Inventory for Medical Students. RESULTS The American Medical Colleges Graduation Questionnaire had an 81% response rate, yielding 26 567 complete participant responses that were included the analysis. A total of 13 645 individuals (51.4%) were male, and 3947 (14.9%) identified as URIM (ie, Alaska Native, Black, Hispanic/Latinx, Native American, and/or Pacific Islander). Medical students who are URIM reported modestly higher levels of exhaustion-related burnout (mean [SD], 11.84 [3.62] vs 11.48 [3.61]; P < .001) and modestly lower mean burnout scores associated with disengagement (mean [SD], 9.24 [3.56] vs 9.36 [3.58]; P = .047). Medical students who are URIM also reported marginally less favorable student-faculty interactions in the learning environment (mean [SD], 14.09 [3.45] vs 14.29 [3.35]; P < .001). Medical students who are URIM were more likely to be in the top quartile of those who experienced exhaustion-related burnout (odds ratio, 1.19 [95% CI, 1.09-1.29]) but less likely to be in the top quartile for disengagement (odds ratio, 0.87 [95% CI, 0.80-0.94]). Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination. CONCLUSIONS AND RELEVANCE This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout. This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility, and/or recurrent discrimination. The learning environment can play a key role in mitigating burnout in both medical students who are URIM and those who are not and is deserving of further research.
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Affiliation(s)
| | | | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth Samuels
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dowin Boatright
- Yale School of Medicine, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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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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50
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Foong LH. Anti-racism in the emergency department: Navigating clinician experiences of racism. Emerg Med Australas 2021; 34:116-119. [PMID: 34965613 DOI: 10.1111/1742-6723.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Lai Heng Foong
- Emergency Department, Bankstown Lidcombe Hospital, Sydney, New South Wales, Australia
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