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ACOG Committee Statement No. 10: Racial and Ethnic Inequities in Obstetrics and Gynecology. Obstet Gynecol 2024; 144:e62-e74. [PMID: 39146552 DOI: 10.1097/aog.0000000000005678] [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: 06/13/2024] [Indexed: 08/17/2024]
Abstract
Disparate health outcomes and unequal access to care have long plagued many communities in the United States. Individual demographic characteristics, such as geography, income, education, and race, have been identified as critical factors when seeking to address inequitable health outcomes. To provide the best care possible, obstetrician-gynecologists should be keenly aware of the existence of and contributors to health inequities and be engaged in the work needed to eliminate racial and ethnic health inequities. Obstetrician-gynecologists should improve their understanding of the etiologies of health inequities by participating in lifelong learning to understand the roles clinician bias and personally mediated, systemic, and structural racism play in creating and perpetuating adverse health outcomes and health care experiences.
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Lee A, Hastie M. Recognising and managing bias and prejudice in healthcare. BJA Educ 2024; 24:245-253. [PMID: 38899317 PMCID: PMC11184476 DOI: 10.1016/j.bjae.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- A. Lee
- University of Pennsylvania, Philadelphia, PA, USA
| | - M. Hastie
- Columbia University Irving Medical Center, New York, NY, USA
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Alhassan JAK, Khare NS, Tanvir A. Variegated racism: exploring experiences of anti-Black racism and their progression in medical education. CMAJ 2024; 196:E751-E759. [PMID: 38857932 PMCID: PMC11173657 DOI: 10.1503/cmaj.231753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Addressing anti-Black racism in medical education in Canada has become increasingly urgent as more Black learners enter medical institutions and bring attention to the racist harms they face. We sought to gather evidence of experiences of racism among Black medical learners and to explore the contexts within which racism is experienced by learners. METHODS Drawing on critical race and structural violence theories, we conducted interviews with Black medical faculty, students, residents, and staff at the University of Saskatchewan College of Medicine between May and July 2022. We thematically analyzed interviews using instrumental case study methodology. RESULTS Thematic analyses from 13 interviews revealed 5 central themes describing experiences of racism and the compounding nature of racist exposures as learners progressed in medicine. Medical learners experienced racism through uncomfortable encounters and microaggressions. Blatant acts of racism were instances where patients and superiors harmed students in various ways, including through use of the N-word by a superior in 1 instance. Learners also experienced curricular racism through the absence of the Black body in the curriculum and the undue pathologizing of Blackness. Medical hierarchies reinforced anti-Black racism by undermining accountability and protecting powerful perpetrators. Finally, Black women medical learners identified intersecting oppressions and misogynoir that compounded their experience of racism. We propose that experiences of racism may worsen as learners progress in medicine in part because of increases in the sources of and exposure to racism. INTERPRETATION Anti-Black racism in medical education in Canada is experienced subtly through microaggressions or blatantly from different sources including medical faculty. As Black learners progress in medicine, anti-Black racism may become worse because of the compounding effects of exposures to a wider range of sources of racist behaviour.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology (Alhassan), College of Medicine, University of Saskatchewan, Saskatchewan, Sask.; Department of Family Medicine (Khare), University of British Columbia, Vancouver, BC; College of Medicine (Tanvir), University of Saskatchewan, Saskatchewan, Sask.
| | - Nikisha Shally Khare
- Department of Community Health and Epidemiology (Alhassan), College of Medicine, University of Saskatchewan, Saskatchewan, Sask.; Department of Family Medicine (Khare), University of British Columbia, Vancouver, BC; College of Medicine (Tanvir), University of Saskatchewan, Saskatchewan, Sask
| | - Azasma Tanvir
- Department of Community Health and Epidemiology (Alhassan), College of Medicine, University of Saskatchewan, Saskatchewan, Sask.; Department of Family Medicine (Khare), University of British Columbia, Vancouver, BC; College of Medicine (Tanvir), University of Saskatchewan, Saskatchewan, Sask
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Biggers A, Binder A, Gerber BS. Microaggressions and Resiliency During Residency: Creating More Inclusive Environments. Am J Med 2024; 137:459-463. [PMID: 38280554 DOI: 10.1016/j.amjmed.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Affiliation(s)
- Alana Biggers
- Chicago College of Medicine, University of Illinois, Chicago, Ill.
| | - Ashley Binder
- Chicago College of Medicine, University of Illinois, Chicago, Ill
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Skan O, Tregidgo L, Tizzard J, Westlake I, Joji N. Examining medical students' experience of gender-based discrimination and sexual harassment from clinical teachers at a UK medical school. MEDICAL TEACHER 2024:1-9. [PMID: 38564885 DOI: 10.1080/0142159x.2024.2331034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF THE ARTICLE To quantify the prevalence and characterise the nature of gender-based discrimination (GBD) and sexual harassment (SH) arising from clinical teachers towards medical students at one UK medical school. MATERIALS AND METHODS A mixed quantitative and qualitative survey of medical students. Chi-squared analysis and logistic regression was performed on quantitative data, while an inductive thematic analysis of qualitative data was undertaken. These findings were compared to look for common patterns. RESULTS Females were significantly more likely to report experiencing both GBD (χ2 = 38.61, p < 0.0001) and SH (χ2 = 19.53, p < 0.0001) than males (OR = 10.45 (CI 4.84 - 22.56, p < 0.0001)). These behaviours were more likely to be reported in specific surgical placements than medical placements (χ2 = 15.06, p < 0.001 and χ2 = 5.90, p < 0.05). Perpetrators were more commonly male, and more commonly consultants. Exposure to GBD or SH was significantly more likely to affect the choice of specialty in females compared to males (χ2 = 11.17, p < 0.001). Students noted a casual use of sexist language, inappropriate sexual advances, and gender-based microaggressions which create a pervasive discrepancy in educational opportunities between genders. Participants reported that concerns regarding anonymity, questioning the severity of the incident, and an ingrained medical hierarchy prevented students reporting these incidents. CONCLUSIONS The rate of GBD and SH from clinical teachers to medical students remains high, affecting female students more than male students. This study highlights key areas that must be improved to achieve a more equitable teaching experience in UK medical schools. Developing robust reporting and support systems is an important step in eradicating these behaviours.
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Affiliation(s)
- Oliver Skan
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Laura Tregidgo
- Medical Sciences Division, University of Oxford, United Kingdom
| | - James Tizzard
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Isabel Westlake
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Nikita Joji
- Royal Free London NHS Trust, London, United Kingdom
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Williamson FA, Sharp SN, Hills GD, Dilly CK, Nabhan ZM. Leveraging Resident-As-Teacher Training for Health Equity Education: A Transformative Approach. TEACHING AND LEARNING IN MEDICINE 2024; 36:222-229. [PMID: 36409564 DOI: 10.1080/10401334.2022.2147529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Issue: Resident teachers play an essential role in medical education and can support broader efforts to advance anti-racism and health equity in medicine. The Accreditation Council for Graduate Medical Education requires programs to provide education about health care disparities so residents can contribute to and lead work in this area. However, the literature includes few examples, frameworks, or strategies for preparing residents to develop the knowledge and skills needed to promote health equity, including in their role as clinical teachers. Evidence: In this article, the authors propose leveraging Resident-as-Teacher training to support residents in learning and teaching for health equity. Gorski's conceptualization of equity literacy provides an evidence-based framework for four main abilities (recognizing, responding, redressing, and cultivating/sustaining) residents and medical students can develop through co-learning about health equity in the clinical learning environment. The authors discuss preconditions, example activities, and assessments strategies for effective health equity education. Based on the principles of social learning theory, the authors recommend that Resident-as-Teacher training be part of an institutional strategy to cultivate a community of practice for health equity education. Implications: Incorporating health equity education into Resident-as-Teacher curriculum offers a potentially transformative part of the broader strategy needed to prepare the next generation of physicians to enact anti-racism and advance health equity.
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Affiliation(s)
- Francesca A Williamson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Office of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sacha N Sharp
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gerard D Hills
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christen K Dilly
- Office of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Richard L. Roudebush VA Hospital, Indianapolis, Indiana, USA
| | - Zeina M Nabhan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Office of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Hayward M, Critcher J. Adultification: risk factors, harmful effects and implications for nursing practice. Nurs Child Young People 2024; 36:14-20. [PMID: 37779324 DOI: 10.7748/ncyp.2023.e1488] [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] [Accepted: 05/16/2023] [Indexed: 10/03/2023]
Abstract
Adultification, whereby children and young people are perceived as older or more mature than they actually are, disproportionately affects those from minority ethnic backgrounds. It can also occur in other contexts, for example when children and young people are placed in a position of adult responsibility. Nurses have a duty to support and protect children and young people, which includes protecting them from adultification and the negative effects it can have on health and well-being. This article discusses strategies nurses can use to prevent adultification - such as developing awareness, avoiding adultifying language and listening to children and young people - and actions to take when suspecting adultification from colleagues.
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Affiliation(s)
- Melanie Hayward
- Institute for Health and Social Care, Buckinghamshire New University, High Wycombe, England
| | - Julie Critcher
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Medway, England
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Levi BH, Ekpa N, Lin A, Smith CW, Volpe RL. The Experience of Medical Scribing: No Disparities Identified. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:153-160. [PMID: 38476633 PMCID: PMC10929157 DOI: 10.2147/amep.s439826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024]
Abstract
Introduction The chronic failure to significantly increase the number of underrepresented minorities (URM) in medicine requires that we look for new mechanisms for channelling URM students through pre-medical education and into medical school. One potential mechanism is medical scribing, which involves a person helping a physician engage in real-time documentation in the electronic medical record. Methods As a precursor to evaluating this mechanism, this survey pilot study explored individuals' experiences working as a medical scribe to look for any differences related to URM status. Of 248 scribes, 159 (64% response rate) completed an online survey. The survey was comprised of 11 items: demographics (4 items), role and length of time spent as a scribe (2 items), and experience working as a scribe (5 items). Results The vast majority (>80%) of participants reported that working as a medical scribe gave them useful insight into being a clinician, provided valuable mentoring, and reinforced their commitment to pursue a career in medicine. The experiences reported by scribes who identified as URM did not differ from those reported by their majority counterparts. Discussion It remains to be seen whether medical scribing can serve as an effective pipeline for URM individuals to matriculate into medical school. But the present findings suggest that the experience of working as a medical scribe is a positive one for URM.
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Affiliation(s)
- Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Ndifreke Ekpa
- University of Houston, HCA Houston Healthcare Kingwood, Houston, TX, USA
| | - Andrea Lin
- Penn State College of Medicine, Hershey, PA, USA
| | | | - Rebecca L Volpe
- Department of Humanities, Penn State College of Medicine, Hershey, PA, USA
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Willson MN, Frazier CC, McKeirnan KC. Training Student Pharmacists in Microaggressions and Gender Inclusive Communication. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100676. [PMID: 38360189 DOI: 10.1016/j.ajpe.2024.100676] [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: 06/02/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The objectives of this study were to describe the implementation of a microaggression and gender inclusive communication (MGIC) module in a required course in a Doctor of Pharmacy curriculum; and to evaluate the impact on student pharmacist knowledge, comfort, and confidence using gender inclusive communication and addressing microaggressions. METHODS Students participated in MGIC module, which included training on microaggressions, and terminology related to gender. The module implementation was evaluated through a pre and post training knowledge assessment and survey of student confidence, comfort, and perceived importance of gender inclusive care. Additional evaluation included qualitative review of the graphics depicting the terminology and rephrasing statement with a microaggression to inclusive language. Survey responses were analyzed using Mann-Whitney U test and knowledge responses were analyzed using the Fisher exact test in SPSS. RESULTS A total of 106 students completed the module, 105 completed presurvey and knowledge assessment, and 92 completed the postsurvey and knowledge assessment. Results demonstrated a statistically significant increase from pre to post on the comfort and importance domain questions. A statistically significant increase in the student confidence was seen on all questions except for 2. The pre and postknowledge assessment results on all questions showed improvement from pre to post, although not all changes were statistically significant. CONCLUSION The MGIC module was effective in increasing to evaluate the impact on student pharmacist knowledge, comfort, and confidence using gender inclusive communication and addressing microaggressions. Reflections echoed the value and need for this training.
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Affiliation(s)
- Megan N Willson
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA.
| | - Cheyenne C Frazier
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Kimberly C McKeirnan
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
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Major-Kincade TL. Obstetric Racism, Education, and Racial Concordance. MCN Am J Matern Child Nurs 2024; 49:74-80. [PMID: 38108513 DOI: 10.1097/nmc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
ABSTRACT The United States holds the distinction of being the developed country with the worst perinatal outcomes despite spending the most per capita on health care. Black women are three to four times more likely than White women to experience adverse birth outcomes. These outcomes persist despite access to prenatal care, insurance, and college education. A long overdue racial reckoning has arrived, beginning with acknowledging the fallacy of race-based medicine and the role of enduring systemic racism as foundational to obstetric racism in the reproductive lives of Black women. Centering voices of Black women and honoring their lived experiences are essential to providing respectful maternity care. Naming micro- and macroaggressions experienced by Black women allows for dismantling of systemic barriers which perpetuate inequitable outcomes and enable substandard care. Racial concordance (shared racial identity) is one tool to consider in creating safe health care spaces for Black women. Improving diversity of the nursing workforce specifically, and the health care workforce in general, is necessary to affect racial concordance. Application of skills in cultural humility can mitigate challenges associated with adverse patient encounters for Black women as diversity pipeline strategies are explored. Histories of foundational fallacy, their impact on care and outcomes, and patient-driven indicators for improving pregnancy care experiences for women of color are explored through the lens of a Black physician and the collective reproductive health workforce.
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Affiliation(s)
- Terri L Major-Kincade
- Terri L. Major-Kincade is an Associate Professor, Department of Pediatrics, Director, Pediatric Palliative Care Service Memorial Hermann Children's Hospital, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX. Dr. Major-Kincade can be reached at
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Goldberg SB, Tanana M, Stewart SH, Williams CY, Soma CS, Atkins DC, Imel ZE, Owen J. Automating the assessment of multicultural orientation through machine learning and natural language processing. Psychotherapy (Chic) 2024:2024-50442-001. [PMID: 38300571 PMCID: PMC11291704 DOI: 10.1037/pst0000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Recent scholarship has highlighted the value of therapists adopting a multicultural orientation (MCO) within psychotherapy. A newly developed performance-based measure of MCO capacities exists (MCO-performance task [MCO-PT]) in which therapists respond to video-based vignettes of clients sharing culturally relevant information in therapy. The MCO-PT provides scores related to the three aspects of MCO: cultural humility (i.e., adoption of a nonsuperior and other-oriented stance toward clients), cultural opportunities (i.e., seizing or making moments in session to ask about clients' cultural identities), and cultural comfort (i.e., therapists' comfort in cultural conversations). Although a promising measure, the MCO-PT relies on labor-intensive human coding. The present study evaluated the ability to automate the scoring of the MCO-PT transcripts using modern machine learning and natural language processing methods. We included a sample of 100 participants (n = 613 MCO-PT responses). Results indicated that machine learning models were able to achieve near-human reliability on the average across all domains (Spearman's ρ = .75, p < .0001) and opportunity (ρ = .81, p < .0001). Performance was less robust for cultural humility (ρ = .46, p < .001) and was poorest for cultural comfort (ρ = .41, p < .001). This suggests that we may be on the cusp of being able to develop machine learning-based training paradigms that could allow therapists opportunities for feedback and deliberate practice of some key therapist behaviors, including aspects of MCO. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Simon B Goldberg
- Department of Counseling Psychology, University of Wisconsin-Madison
| | | | | | | | | | | | | | - Jesse Owen
- Department of Counseling Psychology, University of Denver
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Hill Weller L, Rubinsky AD, Shade SB, Liu F, Cheng I, Lopez G, Robertson A, Smith J, Dang K, Leiva C, Rubin S, Martinez SM, Bibbins-Domingo K, Morris MD. Lessons learned from implementing a diversity, equity, and inclusion curriculum for health research professionals at a large academic research institution. J Clin Transl Sci 2024; 8:e22. [PMID: 38384906 PMCID: PMC10879992 DOI: 10.1017/cts.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Despite advances in incorporating diversity and structural competency into medical education curriculum, there is limited curriculum for public health research professionals. We developed and implemented a four-part diversity, equity, and inclusion (DEI) training series tailored for academic health research professionals to increase foundational knowledge of core diversity concepts and improve skills. Methods We analyzed close- and open-ended attendee survey data to evaluate within- and between-session changes in DEI knowledge and perceived skills. Results Over the four sessions, workshop attendance ranged from 45 to 82 attendees from our 250-person academic department and represented a mix of staff (64%), faculty (25%), and trainees (11%). Most identified as female (74%), 28% as a member of an underrepresented racial and ethnic minority (URM) group, and 17% as LGBTQI. During all four sessions, attendees increased their level of DEI knowledge, and within sessions two through four, attendees' perception of DEI skills increased. We observed increased situational DEI awareness as higher proportions of attendees noted disparities in mentoring and opportunities for advancement/promotion. An increase in a perceived lack of DEI in the workplace as a problem was observed; but only statistically significant among URM attendees. Discussion Developing applied curricula yielded measurable improvements in knowledge and skills for a diverse health research department of faculty, staff, and students. Nesting this training within a more extensive program of departmental activities to improve climate and address systematic exclusion likely contributed to the series' success. Additional research is underway to understand the series' longer-term impact on applying skills for behavior change.
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Affiliation(s)
- LaMisha Hill Weller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Office of Diversity and Outreach, University of California, San Francisco, CA, USA
| | - Anna D. Rubinsky
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Felix Liu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Georgina Lopez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Asha Robertson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jennifer Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristina Dang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Christian Leiva
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Susan Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Suzanna M. Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Staub M, Han B, Lee Hill A, Thomson E, Martin JL, Hoffmann R, Osborn TM, McCormick M, Ogden MA, Chilson K, Eckhouse SR. Does gender affect experiences in the operating room for surgeons and anesthesiologists at a large academic center? Am J Surg 2024; 227:63-71. [PMID: 37821294 DOI: 10.1016/j.amjsurg.2023.09.033] [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: 06/30/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Although the number of women medical trainees has increased in recent years, they remain a minority of the academic workforce. Gender-based implicit biases may lead to deleterious effects on surgical workforce retention and productivity. METHODS All 440 attending surgeons and anesthesiologists employed at our institution were invited to complete a survey regarding perceptions of the perioperative work environment and resources. Odds ratios for dichotomous variables were calculated using logistic regressions, and for trichotomous variables, polytomous regressions. RESULTS 243 participants (55.2%) provided complete survey responses. Relative to men, women faculty reported a greater need to prove themselves to staff; less respect and fewer resources and opportunities; more frequent assumptions about their capabilities; and a greater need to adjust their demeanor to connect with their team (p < 0.05). CONCLUSION Perceived gender bias remains present in the perioperative environment. We need greater efforts to address barriers and create an equitable work environment.
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Affiliation(s)
- Melinda Staub
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Britta Han
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela Lee Hill
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Emily Thomson
- Perioperative Services, Barnes Jewish Hospital, Saint Louis, MO, USA
| | - Jackie L Martin
- Perioperative Services, Barnes Jewish Hospital, Saint Louis, MO, USA
| | | | - Tiffany M Osborn
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Molly McCormick
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - M Allison Ogden
- Department of Otolaryngology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kelly Chilson
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Shaina R Eckhouse
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
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Barry CL, Coombs J, Buchs S, Kim S, Grant T, Henry T, Parente J, Spackman J. Professionalism in Physician Assistant Education as a Predictor of Future Licensing Board Disciplinary Actions. J Physician Assist Educ 2023; 34:278-282. [PMID: 37467183 PMCID: PMC10653293 DOI: 10.1097/jpa.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to evaluate associations between postgraduate disciplinary actions (PGDA) by state licensing boards and physician assistant (PA) school documented professionalism violations (DPV) and academic probation. METHODS This was a retrospective cohort study comprising PA graduates from 2001 to 2011 at 3 institutions (n = 1364) who were evaluated for the main outcome of PGDA and independent variable of DPV and academic probation. Random-effects multiple logistic regression and accelerated failure time parametric survival analysis were used to investigate the association of PGDA with DPV and academic probation. RESULTS Postgraduate disciplinary action was statistically significant and positively associated with DPV when unadjusted (odds ratio [OR] = 5.15; 95% CI: 1.62-16.31; P = .01) and when adjusting for age, sex, overall PA program GPA (GPA), and Physician Assistant National Certifying Exam Score (OR = 5.39; 95% CI: 1.54-18.85; P = .01) (fully adjusted). Academic probation increased odds to 8.43 times (95% CI: 2.85-24.92; P < .001) and 9.52 times (95% CI: 2.38-38.01; P < .001) when fully adjusted. CONCLUSION Students with professionalism violation or academic probation while in the PA school had significant higher odds of receiving licensing board disciplinary action compared with those who did not. Academic probation had a greater magnitude of effect and could represent an intersection of professionalism and academic performance.
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Affiliation(s)
- Carey L Barry
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer Coombs
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Shalon Buchs
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Sooji Kim
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Travis Grant
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Trenton Henry
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jason Parente
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jared Spackman
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
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15
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Hill Weller L, Tang J, Chen R, Boscardin C, Ehie O. Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11360. [PMID: 38034501 PMCID: PMC10682127 DOI: 10.15766/mep_2374-8265.11360] [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: 04/02/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023]
Abstract
Introduction Graduate trainees from diverse backgrounds may experience discrimination, mistreatment, and microaggressions. While the ability to identify and respond to microaggressions is a much-needed skill for all emerging trainees, limited training workshops exist for residents, especially within perioperative medicine. To embody the principles of diversity, equity, inclusion, and anti-racism (DEIA), we aimed to empower trainees in the perioperative environment with several strategies for addressing microaggressions to bridge this training gap. Methods Based on critical race theory, transformative learning, minority stress theory, and the structural theory of gender and power, this workshop was developed with the primary aim of educating trainees on microaggressions, amplifying the role of allyship, and providing tools to respond to microaggressions as an ally. We used a mixed methods approach to examine participants' pre/post self-evaluations of microaggression intervention tools and the overall effectiveness of the workshop. Results The postsurvey captured the experiences of 54 trainees, including 37 of 44 (84%) first-year clinical anesthesia residents and 14 of 24 (58%) surgery residents. The facilitator and course feedback was remarkably positive. Paired t test analyses on participants' pre- and postsurvey responses demonstrated a statistically significant increase in knowledge of microaggressions. This workshop also significantly increased learners' self-reported tools for responding to microaggressions. Discussion Overall, these promising findings suggest that the strategies presented in this workshop could be applied across other graduate medical education programs. Institutions may wish to customize workshop elements, such as the case scenarios, and the workshop can also be incorporated within a DEIA curriculum.
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Affiliation(s)
- LaMisha Hill Weller
- Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine
| | - Janette Tang
- Fourth-Year Medical Student, University of California, San Francisco, School of Medicine
| | - Rebecca Chen
- Fourth-Year Medical Student, University of California, San Francisco, School of Medicine
| | - Christy Boscardin
- Professor, Departments of Medicine and Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine
| | - Odinakachukwu Ehie
- Associate Clinical Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine
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Clare CA, Pardo C, Minkoff H. Divisions of health equity in departments of obstetrics and gynecology. Am J Obstet Gynecol 2023; 229:485-489. [PMID: 37244457 DOI: 10.1016/j.ajog.2023.05.021] [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: 12/04/2022] [Revised: 04/26/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
Disparities in maternal morbidity and mortality remain vivid reminders of the role of racism in obstetrics and gynecology. If a serious attempt is to be made to purge medicine of its ongoing role in unequal care, then departments must commit the same intellectual and material resources as they would to the other health challenges in their remit. A division that understands the unique needs and complexities of the specialty, including translating theory into practice, is uniquely positioned to keep health equity as a focus of clinical care, education, research, and community engagement. To achieve reproductive justice, an approach addressing the intersectionality of race, ethnicity and gender identity is critical. In this article, we detailed the ways in which divisions of health equity within departments of obstetrics and gynecology can dismantle impediments to progress and can move our discipline closer to optimal and equitable care for all. We described the unique educational, clinical, research, and innovative community-based activities of these divisions.
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Affiliation(s)
- Camille A Clare
- Department of Obstetrics and Gynecology, Downstate Health Sciences University, Brooklyn, NY; School of Public Health, Downstate Health Sciences University, Brooklyn, NY.
| | - Christina Pardo
- Department of Obstetrics and Gynecology, Downstate Health Sciences University, Brooklyn, NY; School of Public Health, Downstate Health Sciences University, Brooklyn, NY
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Downstate Health Sciences University, Brooklyn, NY; School of Public Health, Downstate Health Sciences University, Brooklyn, NY; Maimonides Medical Center, Brooklyn, NY
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17
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Azman NBN, Zhou TW, Shorey S. Perceptions of healthcare professionals and students about interventions addressing implicit bias and microaggression: A mixed-studies systematic review. Nurse Educ Pract 2023; 73:103820. [PMID: 37922738 DOI: 10.1016/j.nepr.2023.103820] [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: 08/04/2023] [Revised: 09/29/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
AIM To consolidate and appraise available evidence on the experiences and perceptions of healthcare professionals and students about the interventions addressing implicit bias and microaggression in the clinical setting. BACKGROUND Patient-perpetrated acts of implicit bias and microaggression have profound effects on healthcare professionals' and students' mental health. However, the efficacy of interventions targeted at addressing implicit bias and microaggression requires further scrutiny. DESIGN Mixed-studies systematic review. METHODS A comprehensive search was conducted on PubMed, EMBASE, CINAHL, Scopus, Web of Science, PsycINFO, Cochrane Library, ProQuest (Social Science Premium Collection Database), ProQuest (Dissertations and Theses Global), and ClinicalTrials.gov. Study selection, quality appraisal using the mixed methods appraisal tool, and data extraction were performed. Narrative and thematic synthesis were used to analyze quantitative and qualitative findings respectively. A results-based convergent approach was employed to integrate findings from both research designs. RESULTS A total of 23 studies were included, involving 4667 healthcare professionals and students. There were 17 quantitative studies and six mixed-method studies of varying methodological quality. This review presented findings on healthcare professionals' and students' experiences and perceptions of the efficacy of the interventions targeted at addressing implicit bias and microaggression. Two themes were identified: 1) A safe space leading to enhanced confidence, and 2) what and why the interventions worked. CONCLUSION Our review findings found that healthcare professionals and students generally had a positive view of implicit bias and microaggression interventions in the realm of helping them gain knowledge and confidence to identify and respond to biased clinical encounters. This review could provide insights for administrators and institutions to provide such interventions in mitigating the impact of implicit bias and microaggression on healthcare staff and students. Future research should focus on comparing the views of participants from varied geographical and cultural backgrounds, and those with different healthcare disciplines.
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Affiliation(s)
- Noorhidayah Bte Noor Azman
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Teo Wei Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
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18
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Stephens KC, Redman T, Williams R, Bandstra B, Shah R. Considering Culture and Conflict: A Novel Approach to Active Bystander Intervention. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11338. [PMID: 37649621 PMCID: PMC10462770 DOI: 10.15766/mep_2374-8265.11338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/21/2023] [Indexed: 09/01/2023]
Abstract
Introduction Workplace microaggressions are prevalent in clinical settings and contribute to poorer mental health outcomes, as well as to higher rates of burnout for physicians and students experiencing them. While bystander workshops customarily provide guidance on direct interventions to a general audience, the literature does not yet address workshops in an academic setting that consider the individual's motivations and behavior patterns. We implemented a psychologically informed approach to microaggression training to increase participants' understanding and willingness to undergo behavioral change. Methods We created a survey that included 10 distinct scenarios of discrimination in the clinical setting. Participants' willingness to intervene was assessed on a Likert scale prior to, then following, a 1-hour active bystander intervention workshop conducted virtually. The workshop outlined the role of culture and conflict management style in willingness to intervene. Four modes of intervention were outlined, including direct and indirect methods. Results A total of 78 medical students, graduate students, residents, and faculty members participated in the workshop. Of those, we compared 68 individuals' pre- and postworkshop responses to our questionnaire. We then focused on the 54 participants with no previous training in psychiatry or psychology. Utilizing a Wilcoxon signed rank test, we compared the average pre/post scores of willingness to intervene and found scores to have improved following workshop attendance (Z = -6.339, p < .001). Discussion Our findings suggest that a psychiatrically informed and culturally sensitive approach to active bystander intervention workshops may promote upstanding more effectively in academic medicine.
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Affiliation(s)
- Kathryn C. Stephens
- Fourth-Year Resident, Department of Psychiatry and Behavioral Sciences, Stanford Hospitals and Clinics
| | - Tené Redman
- Fourth-Year Resident, Department of Psychiatry and Behavioral Sciences, Stanford Hospitals and Clinics
| | - Reneé Williams
- Professor of Medicine, Department of Medicine, NYU Grossman School of Medicine
| | - Belinda Bandstra
- Health Sciences Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Ripal Shah
- Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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Pachi A, Kavourgia E, Bratis D, Fytsilis K, Papageorgiou SM, Lekka D, Sikaras C, Tselebis A. Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave. Healthcare (Basel) 2023; 11:2031. [PMID: 37510472 PMCID: PMC10378977 DOI: 10.3390/healthcare11142031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Mental health problems, behavior changes, and addictive issues have been consistently documented among healthcare workers during the pandemic. The objective of this study was to investigate the levels of anger and aggression in relation to psychological resilience and alcohol abuse among healthcare workers during the first wave of the COVID-19 pandemic. A total of 120 physicians and 123 nurses completed an online survey of the Dimensions of Anger Reactions-5 (DAR-5), the Brief Aggression Questionnaire (BAQ), the Brief Resilience Scale (BRS), and the Alcohol Screening questionnaire CAGE which is an acronym for the focus of the questions (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers). Demographic and professional data were also recorded. A total of 53 men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale and one out of ten respondents presented with current problematic alcohol use. Male participants demonstrated lower scores on the DAR-5 scale compared to females. Individuals with current problematic alcohol use displayed higher scores on the BAQ compared to those without alcohol use disorders. Regression analysis revealed that 16.4% of the variance in the BAQ scores can be attributed to scores on the DAR-5, 5.9% to the BRS scores, 2.1% to the CAGE scores, 1.7% to gender, and 1.2% to years of work experience. Mediation analysis highlighted the role of psychological resilience as a negative mediator in the DAR-5 and BAQ relationship. Professional experience and alcohol abuse emerged as positive and negative risk factors contributing to aggression and psychological resilience. The findings hold practical implications for implementing interventions to strengthen resilience in order to compensate for aggressive tendencies and discourage addictive issues.
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Affiliation(s)
- Argyro Pachi
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
| | - Evgenia Kavourgia
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
| | - Dionisios Bratis
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
| | - Konstantinos Fytsilis
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
| | - Styliani Maria Papageorgiou
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
| | - Dimitra Lekka
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
| | - Christos Sikaras
- Nursing Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece;
| | - Athanasios Tselebis
- Psychiatric Department, Sotiria Thoracic Diseases Hospital of Athens, 11527 Athens, Greece; (A.P.); (E.K.); (D.B.); (K.F.); (S.M.P.); (D.L.)
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20
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Real Delor RE, Ayala Saucedo A. [Mistreatment of Paraguayan medical residents in 2022: a multicenter study]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:112-118. [PMID: 37402296 PMCID: PMC10443419 DOI: 10.31053/1853.0605.v80.n2.40440] [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: 03/02/2023] [Accepted: 05/07/2023] [Indexed: 07/06/2023] Open
Abstract
Introducción los residentes de postgrado tienden a sufrir maltratos durante sus prácticas hospitalarias y estos comportamientos abusivos no deben considerarse normales. El objetivo fue describir la frecuencia y las características del maltrato en residentes de medicina del Paraguay en 2022. Metodología se aplicó un diseño observacional de corte transversal. Se incluyó a los residentes de hospitales del Paraguay que aceptaban completar una encuesta online difundida por las redes sociales. Se utilizó un cuestionario de 23 preguntas que evalúa el maltrato psicológico, físico, académico y sexual. Adicionalmente se solicitó datos demográficos, académicos y aspectos relacionados a la denuncia del maltrato. Resultados el cuestionario fue llenado por 348 residentes. La edad media fue 28 ± 3 años y hubo predomino del sexo femenino (63,2%). Participaron residentes de 32 hospitales, la mayoría era de 1° año (50,3%) y de especialidades clínicas (60,6%). Acorde al cuestionario, 339 residentes (97,4%) refirieron algún grado de maltrato. Relacionando las especialidades con el maltrato, el mismo fue mayor en las quirúrgicas: RR 1,4 IC 95% 1,0-1,9 (p 0,01). Los principales responsables del maltrato fueron los residentes superiores (55,2%) y los jefes de salas (31,8%). La denuncia fue realizada por 8% de los afectados. El principal motivo para no denunciar fue el temor a que realizarla le traería problemas (67,8%). Conclusiones el maltrato fue referido por 97,4% de los residentes, siendo mayor en las especialidades quirúrgicas. Urge aplicar medidas preventivas para evitar este tipo de abusos durante la residencia.
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21
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Myers AK, Williams MS, Pekmezaris R. Intersectionality and Its Impact on Microaggression in Female Physicians in Academic Medicine: A Cross-Sectional Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:298-304. [PMID: 37404574 PMCID: PMC10316039 DOI: 10.1089/whr.2022.0101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 07/06/2023]
Abstract
Introduction The burden of microaggressions in the workplace is an ongoing stressor for female physicians in academic medicine. For female physicians of Color or of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual community, this burden is even heavier due to the concept of intersectionality. The goal of this study is to assess frequency of microaggressions experienced by participants. In addition, to explore the associations between microaggression and individual outcomes, patient care practices and attitudes, and perception of pay/promotion equity. Methods This was a cross-sectional analysis of female residents, fellows and attendings conducted from December 2020-January 2021 at Northwell Health across all specialties. One hundred seventeen participants replied to the study in REDCap. They completed questionnaires related to the topics of imposter phenomenon, microaggressions, gender identity salience, patient safety, patient care, counterproductive work behavior and pay and promotion equity. Results A majority of the respondents were white (49.6%) and 15+ years out of medical school (43.6%). Around 84.6% of female physicians endorsed experiencing microaggressions. There were positive associations between microaggressions and imposter phenomenon as well as microaggressions and counterproductive work behavior. There was a negative association between microaggressions and pay equity or promotion. The small sample size did not allow for us to examine differences by race. Discussion Although the number of female physicians continues to rise due to an uptick in female medical school enrollees, female physicians still must deal with the burden of microaggressions in the workplace. Conclusions As a result, academic medical institutions must seek to create more supportive workplace for female physicians.
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Affiliation(s)
- Alyson K. Myers
- Division of Endocrinology, Department of Medicine, North Shore University Hospital, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| | - Myia S. Williams
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
| | - Renee Pekmezaris
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Institute of Health Systems Science, Northwell Health, Manhasset, New York, USA
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22
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Sharda S, Butler K, Al Mandhari M, Mehta S. Microaggressions in anesthesiology and critical care: individual and institutional approaches to change. Can J Anaesth 2023; 70:1026-1034. [PMID: 37268799 DOI: 10.1007/s12630-023-02459-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/04/2023] Open
Abstract
Microaggressions are subtle verbal or nonverbal insults that convey derogatory and negative messages to and about people who belong to oppressed groups. Microaggressions reflect structurally and historically perpetuated societal values, which advantage some groups of people by considering them to be inherently more worthy than others, while simultaneously disadvantaging others. While microaggressions may seem innocuous and are often unintentional, they cause tangible harm. Microaggressions are commonly experienced by physicians and learners working in perioperative and critical care contexts and are often not adequately addressed, for a multitude of reasons, including witnesses not knowing how to respond. In this narrative review, we provide examples of microaggressions towards physicians and learners working in anesthesia and critical care, and offer individual and institutional approaches to managing such incidents. Concepts of privilege and power are introduced to ground interpersonal interventions within the larger context of systemic discrimination, and to encourage anesthesia and critical care physicians to contribute to systemic solutions.
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Affiliation(s)
- Saroo Sharda
- Department of Anesthesia, Faculty of Health Sciences, McMaster University, 1280 Main St. W., Hamilton, ON, L8S 4L8, Canada.
| | - Kat Butler
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Maha Al Mandhari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health, Toronto, ON, Canada
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Rock LK, Morse KJ, Eppich W, Rudolph JW. Transforming Team Culture: A Case Study From Critical Care. Chest 2023; 163:1448-1457. [PMID: 36642367 DOI: 10.1016/j.chest.2022.12.046] [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: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 01/13/2023] Open
Abstract
Interprofessional team conflict amplifies division and impedes patient care. Normal differences of opinion escalate to frank conflicts when members respond with indignation or resentment. These behaviors engender a workplace culture that degrades collaborative clinical management and patient safety. We describe the impacts of dysfunctional team culture along with interventions that can lead to more productive teams. In our case study, an interprofessional group of critical care clinicians recognized that their interactions impaired collaborative care and requested support. Two experts, a nurse and a physician, facilitated two 2-h workshops with 18 critical care physicians, nurses, and fellows to begin transforming their dysfunctional unit culture. After establishing psychological safety, facilitators introduced the learning pathways grid to explore (1) how faulty assumptions lead to dysfunctional interactions and suboptimal results and (2) how new assumptions informed by new insights enable teams to redesign their interactions. Through reflection and analysis, clinicians concluded that understanding other clinicians' goals and perspectives benefits patients and families, helps clinicians feel valued, and fosters mutual trust. This exercise supports interprofessional teams to transform dysfunctional interactions by helping team members to develop a mindset of humility and inquiry and to remind themselves about the good intentions in others. To address conflict, we offer a conversational approach grounded in curiosity, respect, and transparency. Ultimately, the most important communication strategy for effective critical care is caring about the perspectives and experiences of other members of the interprofessional team.
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Affiliation(s)
- Laura K Rock
- Beth Israel Deaconess Medical Center, Harvard Medical School, Center for Medical Simulation, Boston, MA.
| | - Kate J Morse
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jenny W Rudolph
- Center for Medical Simulation, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Board of Chiropractic. Dela J Public Health 2022; 8:22-26. [PMID: 36751617 PMCID: PMC9894069 DOI: 10.32481/djph.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Rogo T, Holland S, Fassiotto M, Maldonado Y, Joseph T, Ramilo O, Byrd K, Delair S. Strategies to Increase Workforce Diversity in Pediatric Infectious Diseases. J Pediatric Infect Dis Soc 2022; 11:S148-S154. [PMID: 36477593 DOI: 10.1093/jpids/piac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The number of physicians who are underrepresented in medicine within the pediatric infectious diseases workforce remains disproportionate compared to the US population. Physician workforce diversity plays an important role in reducing health care disparities. Pathways to careers in pediatric infectious diseases require that a diverse pool of students enter medicine and subsequently choose pediatric residency followed by subspecialty training. Efforts must be made to expose learners to pediatric infectious diseases earlier in the education timeline. Along with recruitment and creation of pathways, cultures of inclusivity must be created and fostered within institutions of learning along the entire spectrum of medical training.
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Affiliation(s)
- Tanya Rogo
- Division of Pediatric Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sabina Holland
- Division of Pediatric Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Magali Fassiotto
- Office of Faculty Development & Diversity, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yvonne Maldonado
- Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tuhina Joseph
- Division of Pediatric Infectious Diseases, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Octavio Ramilo
- Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katrina Byrd
- Division of Pediatric Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shirley Delair
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Racism in Medicine:. Dela J Public Health 2022; 8:66-72. [PMID: 36340947 PMCID: PMC9621581 DOI: 10.32481/djph.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Kidd VD, Spisak JM, Vanderlinden S, Kayingo G. A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs. BMC MEDICAL EDUCATION 2022; 22:598. [PMID: 35922854 PMCID: PMC9351247 DOI: 10.1186/s12909-022-03664-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors' attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs. METHOD A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP). RESULTS The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%). CONCLUSION The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.
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Affiliation(s)
- Vasco Deon Kidd
- School of Medicine, Department of Orthopaedic Surgery, University of California Irvine (UCI Health), 101 The City Dr S, Orange, CA, 92868, USA.
| | - Jennifer M Spisak
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, 545 First Avenue, Greenberg Hall Suite 6B, New York, NY, 10016, USA
| | - Sarah Vanderlinden
- Department of Surgery, Trauma and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gerald Kayingo
- Graduate School, University of Maryland Baltimore, Baltimore, MD, USA
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Velin L, Chew MS, Pompermaier L. Discrimination in an "equal country"-a survey amongst Swedish final-year medical students. BMC MEDICAL EDUCATION 2022; 22:503. [PMID: 35761244 PMCID: PMC9238226 DOI: 10.1186/s12909-022-03558-6] [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: 10/26/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden. METHODS A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher's exact test, and logistic regression. Free-text answers were analyzed thematically using the "Master Suppression techniques" conceptual framework. RESULTS Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported "large" or "extreme" impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001). CONCLUSIONS Discrimination appears to be frequent in medical school, even in one of the world's "most equal countries". Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.
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Affiliation(s)
- Lotta Velin
- Centre for Teaching & Research in Disaster Medicine and Traumatology (KMC), Department of Biomedical and Clinical Sciences, Linköping University, Johannes Magnus väg 11, 583 30, Linköping, Sweden.
| | - Michelle S Chew
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- ANOPIVA US, Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Linköping, Sweden
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Chandan P, Fuentes M. Equity: Critical Conversations-Introduction. PM R 2022; 14:699-705. [PMID: 35736571 DOI: 10.1002/pmrj.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Priya Chandan
- Division of Physical Medicine and Rehabilitation, University of Louisville School of Medicine, Louisville, Kentucky, USA.,Kramer Davis Health, Louisville, Kentucky, USA
| | - Molly Fuentes
- Rehabilitation Medicine, Seattle Children's and University of Washington, Seattle, Washington, USA
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Valdez P, Kendrick-Allwood S, Williams TS, Spinks-Franklin A, Nyp SS. Let Me Spell It Out: The Impact of Microaggression on the Health Care Professional. J Dev Behav Pediatr 2022; 43:303-306. [PMID: 35442924 DOI: 10.1097/dbp.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
CASE Rachel is a 10-year-old White girl with attention-deficit/hyperactivity disorder and a history of trauma who presented for evaluation by Dr. Narayanaswamy, a developmental-behavioral pediatrician. A pediatric resident observed the visit with permission from Rachel's parents.During the visit, Dr. Narayanaswamy spoke to Rachel's case manager over the phone to advocate for a trauma-based day treatment program at her school. At the end of the call, the case manager asked the physician for her full name. Dr. Narayanaswamy responded with her name and asked the case manager, "Would you like me to spell it?" At that time, Rachel's father began to laugh, shook his head, and incredulously remarked, "Ugh, yeah you need to spell it." Dr. Narayanaswamy ignored the comment and completed the phone call.After the visit, Dr. Narayanaswamy explained to the resident that the father's derisive laughter was a microaggression. The resident appreciated the observation and, after a pause, asked why she chose not to defend herself when the microaggression occurred. Dr. Narayanaswamy reflected that she had refrained from responding to Rachel's father over concern that he would retaliate by providing low ratings on the postvisit patient satisfaction survey sent to all patients who received care at the institution. The granular survey results, comprising ratings in each survey subheading category for each clinician, are made public to members of her division each quarter, and low ratings are scrutinized by the leadership. Dr. Narayanaswamy thought it unfortunate that she felt inhibited in her response because this deprived the resident of observing ways to address microaggressions during an encounter, deprived herself the opportunity to respond directly to Rachel's father, and deprived Rachel from an instructive moment about racial empathy.Dr. Narayanaswamy wrote a letter about the incident to the chief of clinical affairs to inquire what recourse clinicians had in these situations and whether certain patient encounters could be flagged to prevent the postvisit patient survey from being automatically sent. The chief responded that the incident was unfortunate and praised Dr. Narayanaswamy's restraint and professionalism but denied her request to have postvisit surveys blocked for certain encounters. He shared that if a clinician were to be dissatisfied with a visit satisfaction rating, the clinician could petition for a review, and a committee would subsequently determine whether the review could be removed.How can health care professionals respond to microaggressions while maintaining a therapeutic alliance with the patient/family members and how can institutions support health care professionals in this endeavor?
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Affiliation(s)
- Purnima Valdez
- Division of Pediatric Neurology, Duke University Medical Center, Duke University School of Medicine, Durham, NC
| | - Salathiel Kendrick-Allwood
- Developmental Progress Clinic, Divisions of General Pediatrics & Neonatology, Emory University School of Medicine, Department of Pediatrics & Children's Pediatric Institute, Atlanta, GA
| | | | - Adiaha Spinks-Franklin
- Division of Developmental Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Sarah S Nyp
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO
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Gouger DH, Sankaran Raval M, Hussain RS, Bastien A. Examining intersectionality in anesthesiology training, academics, and practice. Curr Opin Anaesthesiol 2022; 35:201-207. [PMID: 35165234 DOI: 10.1097/aco.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Intersectionality, or the overlapping nature of social categorizations, such as race, class, and gender, creates interdependent systems of discrimination, disadvantage, and health disparities. The present review examines common shortcomings to diversity management, and proposes targeted improvement frameworks for anesthesiology departments that would offer competitive advantage in training, hiring, and retention, and improved care delivery aimed toward reducing health disparities. RECENT FINDINGS Studies highlight that physicians equipped to care for diverse populations enhance patient-doctor interactions and reduce health disparities. Moreover, untrained providers and staff who engage in disrespectful behaviors like microaggressions can lead to staff turnover and millions of dollars in lost revenue. Underrepresented minorities continue to have lower faculty academic rank in anesthesiology, fewer partnership opportunities in private practice, and disparate research funding. Diversity-based education and training often overlooks intersectionality and reductively illustrates diverse groups as internally homogenous. Even these developing diversity efforts have become politicized and are perceived as uninteresting, irrelevant to medical practice, or unable to create organizational change. SUMMARY The synergy of intersectionality mounts considerable challenges that impact patients, colleagues, and communities of practice. Examining intersectionality in education and workplace policy affords tremendous opportunity for improving quality of care for marginalized populations, reducing healthcare costs, and normalizing culture that is inclusive, equitable, and empowering.
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Affiliation(s)
- Daniel H Gouger
- Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Marie Sankaran Raval
- Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Rashid S Hussain
- Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Alexandra Bastien
- Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, New York, USA
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Abstract
PURPOSE OF REVIEW Although recent census demonstrates that women comprise 50.8% and ethnic minority groups collectively consist of 42.1% of the US population, the field of anesthesiology still demonstrates disparity in representation and health outcomes across race, ethnicity, and gender. In addition, the growing percentage of people that identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ) compounded with limited representation among providers of their care can augment existing disparate outcomes within this community. RECENT FINDINGS Compared to male colleagues, women physicians across all specialties have a decreased likelihood of professorship as well as equitable pay and leadership roles. Additionally, a 2019 study of anesthesia residents across race and ethnicity within the Accreditation Council for Graduate Medical Education established that whites were 58.9%, Asians were 24.7%, Hispanics were 7.8%, Blacks were 5.9%, multiracial groups were 3.8%, and Native Americans were 0.3% of the total 6272 residents. In a survey of members of the American Society of Anesthesiologists, self-identification as part of the sexual and gender minoritycommunity was independently associated with an increased risk of burnout. Furthermore, teams with higher diversity in cognitive styles solve problems more efficiently. SUMMARY To achieve an optimized quality of healthcare, anesthesiologists and other providers should be a reflection of the communities they serve, including women, people of color, and LGBTQ. In this way, there is an increased likelihood of empathy, effective communication, and insightful perspectives on how to bridge the gap in health equity. A diverse lens is essential to ensure grassroots efforts lead to lasting transformational change.
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Affiliation(s)
- Jennifer Chiem
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Justin Libaw
- Department of Anesthesia and Perioperative Services, University of California, San Francisco Benioff Children's Hospital, San Francisco, California, USA
| | - Odinakachukwu Ehie
- Department of Anesthesia and Perioperative Services, University of California, San Francisco Benioff Children's Hospital, San Francisco, California, USA
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Douglas PS, Mack MJ, Acosta DA, Benjamin EJ, Biga C, Hayes SN, Ijioma NN, Jay-Fuchs L, Khandelwal AK, McPherson JA, Mieres JH, Roswell RO, Sengupta PP, Stokes N, Wade EA, Yancy CW. 2022 ACC Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace. J Am Coll Cardiol 2022; 79:2153-2184. [DOI: 10.1016/j.jacc.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goulart MF, Huayllani MT, Balch Samora J, Moore AM, Janis JE. Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e4062. [PMID: 34963876 PMCID: PMC8694515 DOI: 10.1097/gox.0000000000004062] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training. METHODS A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson's chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables. RESULTS One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees (P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees (P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees (P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1-2 and 3-4 integrated residents (P < 0.05). CONCLUSIONS Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.
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Affiliation(s)
- Micheline F. Goulart
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Maria T. Huayllani
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julie Balch Samora
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Amy M. Moore
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
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Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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