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Smith SE, Livingston P, Carney E, Mardon J, Tallentire VR. Snakes and ladders: An integrative literature review of refugee doctors' workforce integration needs. MEDICAL EDUCATION 2024; 58:782-796. [PMID: 38102966 DOI: 10.1111/medu.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Healthcare systems worldwide are facing a workforce crisis; meanwhile, refugee doctors throughout the world face difficulties in accessing work. The aims of this review were to explore the integration needs of refugee doctors into host healthcare systems from the refugee perspective, synthesise the literature to construct a theory of refugee doctor integration needs and explore how these needs are met or challenged on the pathway to full integration. METHODS In this integrative literature review, 11 databases and eight grey literature sources were searched by combining terms for refugee doctor and social integration and limiting to research published in or after 2003. Data were extracted, and quality scoring was completed independently by two researchers. This study utilised template analysis to perform a qualitative synthesis of the data. The multidimensional template included a pre-defined template based on a theoretical framework and a concurrent fully inductive template. RESULTS Twenty-two papers were included, incorporating the views of 339 doctors from 30 different home countries and 10 different host countries. The resultant theory included 'foundations' (rights and responsibilities) and three pillars. The 'learning' pillar included required knowledge and skills acquisition. The 'being' pillar encompassed necessary identity work. The 'connecting' pillar comprised social connections, which impacted all other domains. The random and non-linear path to integration faced by refugee doctors was also presented as a serious game. DISCUSSION This study produced a theory exploring refugee doctors' integration needs and how these are met or challenged. Medical educators developing courses for refugee doctors should attend not only to knowledge and skills acquisition but also social connections, identity work and rights and responsibilities. The theory highlights the central importance of social connections. Medical educators can therefore have a transformative impact on refugee doctors' integration. This may also contribute to society by helping to alleviate the workforce crisis.
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Affiliation(s)
- Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- NHS Lothian, Edinburgh, UK
| | | | | | - Julie Mardon
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Emergency Medicine and Clinical Integration, NHS Forth Valley, Larbert, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- NHS Lothian, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
- NHS Education for Scotland, Edinburgh, UK
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Mokhachane M, Wyatt T, Kuper A, Green-Thompson L, George A. Graduates' Reflections on Professionalism and Identity: Intersections of Race, Gender, and Activism. TEACHING AND LEARNING IN MEDICINE 2024; 36:312-322. [PMID: 37334670 DOI: 10.1080/10401334.2023.2224306] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023]
Abstract
Phenomenon: Professionalism as a construct is weaponized to police and punish those who do not fit the norm of what a medical professional should look like or behave, more so when medical professionals in training engage in protests for social justice. In addition, professionalism silences trainees, forcing them not to question anything that looks or feels wrong in their eyes. Socialization in medicine, in both the undergraduate and postgraduate training spaces, poses challenges for contemporary medical professionals who are expected to fit the shape of the 'right kind of doctor.' Intersectionality seems to impact how medical trainees experience professionalism, be it intersections of gender, race, how they dress or adorn themselves, how they carry themselves and who they identify as. Although there is literature on the challenges pertaining to professionalism, not much has been written about the weaponization of professionalism in medical training, particularly in the South African context. There is also a paucity of data on experiences of professionalism during or after social upheaval. Approach: This is part of a study that explored the experiences of professionalism of five medical trainees during protests and after protests, extending into their postgraduate training. The main study had 13 participants, eight students and five graduates, who were all interviewed in 2020, five years after the #FeesMustFall protests. For the five postgraduate participants, we looked at how gender, race, hairstyles, adornment, and protests played out in the experiences of professionalism as medical trainees at a South African university. We employed a qualitative phenomenological approach. An intersectional analytical lens was used in analyzing the transcripts of the five graduate participants. Each transcript was translated as the story of that participant. These stories were compared, looking for commonalities and differences in terms of their experiences. Findings: The participants, four males (three Black and one white) and one Black female, were victimized or judged based on their activism for social justice, gender, and race. They were made to feel that having African hairstyles or piercings was not professional. Insights: Society and the medical profession has a narrow view of what a doctor should look like and behave - it should not be someone who wears their hair in locks, has body piercing, or is an activist, least of all if she is a woman, as professionalism is used as a weapon against all these characteristics. Inclusivity should be the norm in medical education.
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Affiliation(s)
- Mantoa Mokhachane
- Unit of Undergraduate Medical Education, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Tasha Wyatt
- Centre for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ayelet Kuper
- Department of Medicine and The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lionel Green-Thompson
- Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa
| | - Ann George
- Centre for Health Science Education, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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Ludwig S, Jenner S, Berger R, Tappert S, Kurmeyer C, Oertelt-Prigione S, Petzold M. Perceptions of lecturers and students regarding discriminatory experiences and sexual harassment in academic medicine - results from a faculty-wide quantitative study. BMC MEDICAL EDUCATION 2024; 24:447. [PMID: 38658938 PMCID: PMC11044556 DOI: 10.1186/s12909-024-05094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 01/24/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Discrimination and sexual harassment are prevalent in higher education institutions and can affect students, faculty members and employees. Herein the aim was to assess the extent of discriminatory experiences and sexual harassment of students and lecturers at one of the largest teaching hospitals in Europe. We analyze whether there are differences between lecturers and students, different study programs as well as sex/gender differences. METHODS In an interdisciplinary, iterative process, a semi-standardized questionnaire was developed and sent to N = 7095 students (S) of all study programs and N = 2528 lecturers (L) at Charité-Universitätsmedizin Berlin, Germany. The study was conducted from November 2018 to February 2019. Besides a broad range of questions on sociodemographic background allowing for diversity sensitive data analysis, they were asked if they had witnessed and/or experienced any form of discrimination or sexual harassment at the medical faculty, if yes, how often, the perceived reasons, situational factors and perpetrators. RESULTS The response rate was 14% (n = 964) for students and 11% (n = 275) for lecturers. A proportion of 49.6% of students (L: 31%) reported that they have witnessed and/or experienced discriminatory behavior. Sexual harassment was witnessed and/or experienced by 23.6% of students (L: 19.2%). Lecturers (85.9%) were identified as the main source of discriminatory behavior by students. Directors/supervisors (47.4%) were stated as the main source of discriminatory behavior by lecturers. As the most frequent perceived reason for discriminatory experiences sex/gender (S: 71%; L: 60.3%) was reported. Women and dental students experienced more discriminatory behavior and sexual harassment. CONCLUSIONS Discriminatory behavior is experienced by a significant number of students and lecturers, with power structures having a relevant impact. Dental students and women appear to be particularly exposed. Specific institutional measures, such as training programs for lecturers and students are necessary to raise awareness and provide resources. Furthermore, national preventive strategies should be thoroughly implemented to fight discrimination and harassment at the workplace.
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Affiliation(s)
- Sabine Ludwig
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, 10117, Berlin, Germany.
- Institute of Diversity in Medicine, Medical University Innsbruck, Innsbruck, Austria.
| | - Sabine Jenner
- Equal Opportunities Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralph Berger
- Department for Teaching and Learning, Quality Assurance Section, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvie Tappert
- Department for Teaching and Learning, MediCoach, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Kurmeyer
- Equal Opportunities Office, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Bielefeld University, Bielefeld, Germany
| | - Mandy Petzold
- Department for Teaching and Learning, Quality Assurance Section, Charité- Universitätsmedizin Berlin, Berlin, Germany
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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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Sorgini A, Istl AC, Downie ML, Kirpalani A. Pride & prejudice: A scoping review of LGBTQ + medical trainee experiences. MEDICAL TEACHER 2024; 46:73-81. [PMID: 37418565 DOI: 10.1080/0142159x.2023.2229503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE LGBTQ + medical trainees experience significant discrimination. These individuals are stigmatized within a hetero- and cis-normative system, resulting in poorer outcomes in mental health and increased stress regarding career trajectory compared with their hetero- and cis-identifying counterparts. However, literature on the barriers experienced during medical training in this marginalized group is limited to small heterogeneous studies. This scoping review collates and explores prominent themes in existing literature on the personal and professional outcomes of LGBTQ + medical trainees. METHODS We searched five library databases (SCOPUS, Ovid-Medline, ERIC, PsycINFO and EMBASE) for studies that investigated LGBTQ + medical trainees' academic, personal, or professional outcomes. Screening and full text review were performed in duplicate, and all authors participated in thematic analysis to determine emerging themes, which were iteratively reviewed to consensus. RESULTS From 1809 records, 45 met inclusion criteria (κ = 0.57). Major themes that emerged in the literature included the prevalence of discrimination and mistreatment faced by LGBTQ + medical trainees from colleagues and superiors, concerns regarding disclosure of sexual and/or gender minority identity, and overall negative impacts on mental health including higher rates of depression, substance use, and suicidal ideation. There was a noted lack of inclusivity in medical education and having an LGBTQ + identity had a large impact on career trajectory. Community with peers and mentors was an important determinant of success and belonging. There was a noteworthy lack of research on intersectionality or positive interventions that improved outcomes for this population. CONCLUSION This scoping review highlighted important barriers facing LGBTQ + medical trainees, identifying substantial gaps in the existing literature. Research on supportive interventions and predictors of training success is lacking and will be important to foster an inclusive education system. These findings provide critical insights for education leaders and researchers to help create and evaluate inclusive and empowering environments for trainees.
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Affiliation(s)
- Alana Sorgini
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alexandra C Istl
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mallory L Downie
- Department of Renal Medicine, University College London, London, UK
- Department of Nephrology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Amrit Kirpalani
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Division of Nephrology, Children's Hospital, London Health Sciences Centre, London, ON, Canada
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Dawood MH, Roshan M, Daniyal M, Sohail S, Perveen H, Islam UU. Gender Inequity in Clinical Clerkships and its Influence on Career Selection: A Cross-Sectional Survey. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241257401. [PMID: 38799175 PMCID: PMC11128173 DOI: 10.1177/23821205241257401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Objective The aim of this study was to identify the frequency, form, and underlying factors contributing to gender inequity experienced by medical undergraduates and assess its influence on their career choices. Method This was a cross-sectional, retrospective survey with a 100% response rate. This survey was distributed among medical students of clinical years in Karachi's private and government medical colleges from September 10th, 2021-March 30th, 2022. 430 participants were enrolled using a simple-random-sampling-technique. Chi-square/Fisher's Exact tests are employed to assess the relationships between gender and gender-based inequity in various specialties, including their characteristics, influence on career choices, adverse psychological effects, and potential mitigation strategies. Results Among 430 respondents, 28.6% were male, and 71.4% were female. 89.1% reported gender inequity, evenly distributed in government (80.4%) and private institutions (88.1%). The general surgery and gynecology disciplines stood out, each with a 56% prevalence. In gynecology and surgery clinical-clerkships, both genders experienced similar rates, with females at 54.5% and 42.3%, and males at 56.7% and 61.6%, respectively (P-value = .000*). Disrespect from staff/professors/patients (48.8%) was the most common manifestation, driven by factors like preferences (73.7%), gender superiority (62.6%), societal attitudes (54%), and cultural norms (50.9%). Furthermore, 82.6% of students reported that gender inequity had a negative impact on their career decision (Male = 82.9%;Female = 82.4%, P-value = .899). Additionally, gender inequity also caused demotivation (78.1%), poor self-esteem (67.2%), helplessness/hopelessness (48.6%), and frustration (45.8%). Conclusions Gender inequity is widely prevalent in the clinical-clerkships, affecting medical students' career decisions and mental health, stressing the need to prioritize and implement solutions at the undergraduate clinical-clerkship level.
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Affiliation(s)
- Muhammad Hamza Dawood
- United Medical and Dental College, affiliated with Jinnah Sindh Medical University in Karachi, Pakistan
| | - Mavra Roshan
- United Medical and Dental College, affiliated with Jinnah Sindh Medical University in Karachi, Pakistan
| | - Muhammad Daniyal
- United Medical and Dental College, affiliated with Jinnah Sindh Medical University in Karachi, Pakistan
| | - Sheza Sohail
- United Medical and Dental College, affiliated with Jinnah Sindh Medical University in Karachi, Pakistan
| | - Haseefa Perveen
- United Medical and Dental College, affiliated with Jinnah Sindh Medical University in Karachi, Pakistan
| | - Umair Ul Islam
- Head of Department of Surgery at United Medical and Dental College, affiliated with Jinnah Sindh Medical University, Karachi, Pakistan
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Ikhlaq H, Agarwal S, Kwok C, Golamgouse H, Derby S, McRae N, Brown MEL, Collin V, Parekh R, Kumar S. Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the UK. BMJ Open 2023; 13:e078314. [PMID: 38154907 PMCID: PMC10759082 DOI: 10.1136/bmjopen-2023-078314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To better understand the broader experience of medical students impacted by discrimination and the support systems they engage with. DESIGN Qualitative study using semi-structured interviews. SETTING Four medical schools based in the UK. PARTICIPANTS 17 medical students were recruited using volunteer and snowball sampling: all students self-identified as being impacted by discrimination. RESULTS 5 themes were identified: feelings of isolation, imposter syndrome and exclusion; a lack of representation and positive role modelling; the importance of peer support; issues relating to the accessibility of support; building support networks through shared experiences and attempts to foster a sense of inclusion through peer and institutionally led initiatives. CONCLUSIONS The findings of this study suggest medical schools could do more to recognise the importance of acknowledging the multiple identities at risk of discrimination held by students, perpetuating feelings of isolation and exclusion. Our research highlights the need for practical systemic initiatives to improve the sense of belonging of medical students who are impacted by discrimination. Medical educators and institutions should consider formal and informal provisions, such as creating time and space for students to meet and share experiences, access support and reporting networks, to foster a greater sense of belonging.
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Affiliation(s)
- Hamza Ikhlaq
- Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | | | | | - Megan E L Brown
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
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Evéquoz Y, Pichonnaz L, Dubois J. Influence of a sexism and sexual harassment prevention course on medical students' perceptions of and responses to problematic situations. BMC MEDICAL EDUCATION 2023; 23:939. [PMID: 38066505 PMCID: PMC10709927 DOI: 10.1186/s12909-023-04902-0] [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: 03/01/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Issues of sexism and sexual harassment within the medical field are widespread. The aim of his study was to describe the influence of a training course on the prevention of sexism and sexual harassment on medical students' perceptions and responses to problematic situations in the workplace. METHODS We performed a secondary analysis of the transcripts of 16 medical students' interviews. The data were initially gathered as part of an external evaluation of the course. We decided to further explore these with a focus on potential changes about sexism and sexual harassment awareness induced by the course. Data were analyzed using qualitative thematic analysis. RESULTS Most medical students were aware of the existence of sexism and sexual harassment in the medical environment before the course but were not always able to delineate what could be considered as such or not. The course allowed them to broaden their ability to identify problematic situations, that were somewhat "trivialized" before, and to set a lower cut-off when judging what constitutes sexism or sexual harassment. It also provided them with tools on how to react when confronted to these situations, as well as resources to seek help. However, students stressed the importance of such courses also being offered to medical staff higher up in the hierarchy, as they are the ones in a position of power. CONCLUSIONS The course helped students to better identify and react to sexism and sexual harassment. However, given students' lack of power within the hierarchy, efforts to prevent sexism and sexual harassment must be undertaken at an institutional level to allow for change in the system as a whole.
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Affiliation(s)
- Yves Evéquoz
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Lauriane Pichonnaz
- Gender and Health Unit, Department of ambulatory care, University Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julie Dubois
- Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
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Bockaj A, O'Sullivan LF. Romanticizing the Stolen Kiss: Men's and Women's Reports of Nonconsensual Kisses and Perceptions of Impact on the Targets of Those Kisses. JOURNAL OF SEX RESEARCH 2023; 60:1083-1089. [PMID: 35939327 DOI: 10.1080/00224499.2022.2103070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Stolen kisses are often portrayed as resulting from uncontrollable passion and a need to connect intimately with another. This study examined stolen kisses, defined as kissing someone for the first time when the kisser perceived the kiss recipient was not expecting it, and had not provided consent for the kiss. These kisses were examined from the perspective of the individual initiating the kiss. Participants (N = 130; Mage = 32.27; 67% identified as male) completed an anonymous online survey assessing kissing experiences of having stolen a kiss and their open-ended responses were analyzed here. Men were more likely than women to report having stolen a kiss in line with traditional heterosexual scripts. Three scenarios emerged through content analysis: mutual attraction leading to a new relationship; no known mutual attraction but a positive outcome; and no known mutual attraction and a negative outcome. Stealing a kiss from someone for whom there was mutual attraction often led to the onset of an intimate relationship; thus, the kiss constituted a relationship catalyst. When there was no known shared attraction, some interactions ended positively, but others resulted in an end to cordial relations and often strong negative reactions. Findings are discussed in terms of the limited literature on kissing generally and the nonconsensual nature of these events.
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Affiliation(s)
- Amanda Bockaj
- Department of Psychology, University of New Brunswick
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Jarus T, Krupa T, Mayer Y, Battalova A, Bulk L, Lee M, Nimmon L, Roberts E. Negotiating legitimacy and belonging: Disabled students' and practitioners' experience. MEDICAL EDUCATION 2023; 57:535-547. [PMID: 36516022 DOI: 10.1111/medu.15002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 05/12/2023]
Abstract
INTRODUCTION People with disabilities are underrepresented in health professions education and practice. Barriers for inclusion include stigma, disabling discourses, discriminatory programme design and oppressive interactions. Current understandings of this topic remain descriptive and fragmented. Existing research often includes only one profession, excludes particular types of disability and focuses on one aspect of the career journey. To expand understanding, we examined the recurrent forms of social relations that underlie the participation of disabled individuals in learning and practice contexts across five health professions. METHOD We analysed 124 interviews with 56 disabled health practitioners and students. Participants were interviewed up to three times over 1.5 years. Using constructivist grounded theory, authors used a staged analytic approach that resulted in higher level conceptual categories that advance interpretations of social processes. Finally, the authors compared and integrated findings among students and practitioners. RESULTS Participants experience challenges to their sense of legitimacy and belonging as health providers. They describe tensions within the health education and practice between the commitment to inclusion and the day-to-day realities experienced by disabled participants. We identified six distinct, but related, conditions underlying these tensions: (i) validity and transparency of competencies' evaluation; (ii) the social and physical contexts; (iii) integration of inclusive practices; (iv) boundaries between personal and professional identities; (v) vulnerability to authority figures; and (vi) dynamic person-level factors. DISCUSSION If we are to commit to health practitioners and students with disabilities experiencing an overall sense of legitimacy and belonging, priority needs to be given to system-level practices and policies to support inclusion. Attention to the day-to-day marginalisation of students and practitioners with disabilities in the health professions is also needed. Additionally, inclusive and transparent delineation of competency requirements is needed. Finally, educational actions are needed to increase understanding of disability in the health professions, with particular attention to promoting social relations that foster collective responsibility for supporting inclusion.
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Affiliation(s)
- Tal Jarus
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Terry Krupa
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Yael Mayer
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel
| | - Alfiya Battalova
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laura Bulk
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- The Centre for Accessibility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Lee
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Department of Occupational Science & Occupational Therapy, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Health Education Scholarship, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Earllene Roberts
- Disability Resource Centre and AVP Students, University of British Columbia, Kelowna, British Columbia, Canada
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Ibrahim D, Riley R. Female Medical Students’ Experiences of Sexism during Clinical Placements: A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11071002. [PMID: 37046928 PMCID: PMC10094657 DOI: 10.3390/healthcare11071002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
In the UK, more women are studying medicine than men, most of whom have experienced sexism, yet these experiences are under-researched. This qualitative study explores female medical students’ experiences of sexism on placement, impacts sustained, barriers and facilitators encountered upon reporting. A total of 17 semi-structured interviews were conducted, employing purposive sampling, snowball sampling and an inductive thematic analysis. A qualitative methodology was underpinned by the feminist social constructionist theory. Four themes were identified: 1—experiences of sexism, comprising physical and verbal harassment and microaggressions; 2—negative impacts of sexist encounters ranged from psychosocial to repercussions on learning and development; 3—systemic and attitudinal barriers to reporting; 4—recommendations to tackle sexism shaped by the views and experiences of female medical student participants. Female medical students experienced wide-ranging sexism which negatively impacted their wellbeing with negative repercussions for their training and development. The barriers to reporting need to be urgently addressed, and systems, policies and processes need to be over-hauled to sensitively, effectively and equitably manage and provide justice to students who experience and report sexism. Students need to be empowered to respond, report and be offered psychological safety in doing so. Attitudes and practices which are complicit in sustaining sexism need to be challenged and changed.
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Affiliation(s)
- Darya Ibrahim
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Ruth Riley
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK
- Correspondence:
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Summers OS, Medcalf R, Hubbard KA, McCarroll CS. A cross-sectional study examining perceptions of discriminatory behaviors experienced and witnessed by veterinary students undertaking clinical extra-mural studies. Front Vet Sci 2023; 10:940836. [PMID: 37187930 PMCID: PMC10175701 DOI: 10.3389/fvets.2023.940836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Recent research showed that 29% of respondents in a survey of veterinary professionals reported experiencing self-described discrimination in their workplaces. Senior colleagues and clients were responsible for discriminatory behaviors. As part of their training, veterinary students are expected to undertake extra-mural study (EMS) within these same workplaces and are likely to be vulnerable to discrimination from senior colleagues and clients. This study's objectives were to identify and characterize the pattern of perceived discriminatory behaviors (i.e., belief of being treated unfairly) that veterinary students encounter while seeing practice and explore students' attitudes toward discrimination. Methods Students at British and Irish veterinary schools who undertook some clinical EMS completed a survey of closed and open questions as part of a cross-sectional study. Demographic data and experiences of discrimination with details of incidents and reporting were collected, alongside respondent attitudes. Quantitative data were analyzed using Pearson's chi-squared analysis to analyse respondents' characteristics and their experiences of discriminatory behaviors and subsequent reporting. Qualitative content analysis was used for open-question data. Results Of the 403 respondents, 36.0% had perceived behavior they believed was discriminatory. The most frequent form of discrimination was based on gender (38.0%), followed by ethnicity (15.7%). There were significant associations between respondents' experience of discriminatory behaviors and the following characteristics: age (p = 0.0096), disability (p < 0.00001), race/ethnicity (p < 0.0001), gender/sex (p = 0.018), and LGBTQ+ status (p = 0.001). Supervising veterinarians were the most commonly reported perpetrators of discriminatory behaviors (39.3%) compared with clients (36.4%). Only 13.9% of respondents who experienced discrimination reported the event(s). Respondents with a disability were the least likely to agree with the statement that professional bodies are doing enough to tackle discrimination (p < 0.0001). Most respondents agreed that sexism is still an issue (74.4%), but men were more likely to disagree (p = 0.004). Most respondents felt that ethnic diversity needed to be increased (96.3%). Discussion Discriminatory behavior is a problem for students seeing practice, especially those with one or more protected characteristics (as defined by the UK Equality Act 2010). Improved education would need to include perspectives from minority groups to help remove discriminatory behavior from veterinary practice.
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Affiliation(s)
- Olivia S. Summers
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Rebecca Medcalf
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Katherine A. Hubbard
- Department of Sociology, Faculty of Arts and Social Sciences, University of Surrey, Guildford, United Kingdom
| | - Charlotte S. McCarroll
- Department of Comparative Biomedical Sciences, Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- *Correspondence: Charlotte S. McCarroll
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Mahurin HM, Garrett J, Notaro E, Pascoe V, Stevenson PA, DeNiro KL, Shinohara MM. Sexual harassment from patient to medical student: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:824. [PMID: 36451194 PMCID: PMC9710121 DOI: 10.1186/s12909-022-03914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There is little existing research investigating SH/SA specifically from patients to students. This study aims to assess the prevalence and impact of SH and SA from patient to medical student. METHODS A cross-sectional survey study was administered via electronic email list to all current medical students at the University of Washington School of Medicine (n = 1183) over a two-week period in 2019. The survey questions addressed respondents' experiences with SH/SA from patients, frequency of reporting, and impact on feelings of burnout. RESULTS Three hundred eleven responses were received for a response rate of 26%; 268 complete responses were included in the final analysis. Overall, 56% of respondents reported ever experiencing SH from a patient. SH from a patient was reported by significantly more of those who identify as female compared to male (66% vs 31%; p < .001). Similar frequency of experiencing SH within the last year were reported by females and males (90% vs 88%; p = .96). Clinical students were more likely to have ever experienced SH compared to preclinical students (61% vs 39%; p < .001). The majority (86%) of respondents who experienced SH/SA did not report it in an official capacity. Those who identify as female were more likely to report that SH from a patient contributed to feelings of burnout (21% vs 5% for male; p = .02). Behaviors consistent with SA were experienced by 16% of respondents, with similar frequency between females and males. CONCLUSIONS This study demonstrates that patient to medical student SH/SA is a common occurrence, particularly among students identifying as female. It also highlights the significant impact of SH/SA incidents on feelings of burnout.
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Affiliation(s)
- Heather M Mahurin
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Jamie Garrett
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Eliza Notaro
- Division of Dermatology, Department of Medicine, University of Washington, 1959 NE Pacific St., Box 356524, Seattle, Washington, 98195, USA
| | - Vanessa Pascoe
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Philip A Stevenson
- Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Katherine L DeNiro
- Division of Dermatology, Department of Medicine, University of Washington, 1959 NE Pacific St., Box 356524, Seattle, Washington, 98195, USA
| | - Michi M Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, 1959 NE Pacific St., Box 356524, Seattle, Washington, 98195, USA.
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14
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Politis M, El Brown M, Huser CA, Crawford L, Pope L. 'I wouldn't know what to do with the breasts': the impact of patient gender on medical student confidence and comfort in clinical skills. EDUCATION FOR PRIMARY CARE 2022; 33:316-326. [PMID: 36443928 DOI: 10.1080/14739879.2022.2129460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous research has found a relationship between students' gender and attitudes surrounding peer physical examination, but relationship between patient gender and confidence/comfort is less clear. We explored whether patient gender affects medical students' levels of confidence and comfort in clinical examination skills. METHODS An electronic survey and focus groups were conducted with medical students from one UK institution. Students reported levels of confidence/comfort when carrying out clinical examinations on men/women. An inductive thematic analysis was performed. RESULTS Of a total of 1500 students provided with the opportunity to participate, ninety (6%) responded. For cardiovascular and respiratory examinations, confidence/comfort were higher when examining male-presenting patients. The opposite was true for mental state examinations. Barriers to confidence/comfort included perceiving males as a norm, difficulty navigating breasts, tutors' internalised gendered attitudes and a wider sociocultural issue. Facilitators of confidence/comfort included students relating to patients, embodying a professional role, gender blindness, and authentic clinical environments. Fewer than 20% (n = 18) of students felt they had enough opportunity to practice clinical skills on women, versus 90% (n = 82) on men. CONCLUSION Our study identified an area where students' confidence and comfort in clinical examinations could be enhanced within medical education. Changes were implemented in the institution under study's vocational skills teaching, which is rooted in general practice. Information on gender and clinical skills was provided within course handbooks, time was scheduled to discuss gender and clinical skills in small group settings, and equitable gender representation was ensured in clinical assessment.
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Affiliation(s)
- Marina Politis
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Megan El Brown
- Buckingham Medical School, Buckingham Medical School, University of Buckingham, Buckingham, UK.,Medical Education Innovation and Education Centre (MEdIC), Imperial College London, London, UK
| | - Camille Am Huser
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lynsay Crawford
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
| | - Lindsey Pope
- Undergraduate Medical School, University of Glasgow, Glasgow, UK
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15
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Freestone K, Remnant J, Gummery E. Gender discrimination of veterinary students and its impact on career aspiration: A mixed methods approach. Vet Rec Open 2022; 9:e47. [PMID: 36329877 PMCID: PMC9624077 DOI: 10.1002/vro2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As the veterinary profession has become feminised, gender discrimination and its effects have been documented in practicing veterinary surgeons. However, research on gender discrimination experienced by veterinary students and its effects on recruitment and retention remains limited. This study aimed to increase understanding of veterinary students' experiences of gender discrimination and its impact on their career aspirations. METHODS A questionnaire including statements with Likert-style response options and free-text questions was distributed to students studying veterinary medicine and science at a UK veterinary school in September 2020 (28% response rate). Two focus groups were carried out following the questionnaire to gain a deeper insight into student experiences. RESULTS Gender discrimination in a veterinary setting had been experienced by 34% of respondents, the majority (77%) on animal husbandry placements. Female students were more likely to report that their experiences of gender discrimination affected their career aspirations. Seven themes were identified from both the questionnaire and focus group data: stereotyping of certain fields, gender inequality on placements, the lesbian, gay, bisexual, transgender, queer and intersex, plus (LGBTQI+) community, encouraging reporting behaviours, barriers to reporting, education and the placement allocation. CONCLUSIONS This study highlighted that gender discrimination was prevalent during animal husbandry placements, although reporting was infrequent and perceived negatively by students. Recommendations on how veterinary schools and the wider veterinary profession can support veterinary students are made as an outcome of this work.
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Affiliation(s)
- Katie Freestone
- University of NottinghamSchool of Veterinary Medicine and ScienceLoughboroughLeicestershireUK
| | - John Remnant
- University of NottinghamSchool of Veterinary Medicine and ScienceLoughboroughLeicestershireUK
| | - Erica Gummery
- University of NottinghamSchool of Veterinary Medicine and ScienceLoughboroughLeicestershireUK
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Mathieu J, Fotsing S, Akinbobola K, Shipeolu L, Crosse K, Thomas K, Denis-LeBlanc M, Gueye A, Bekolo G. The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students. CMAJ Open 2022; 10:E937-E944. [PMID: 36280249 PMCID: PMC9640166 DOI: 10.9778/cmajo.20220192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Black medical students have been consistently underrepresented in Canadian medical schools, and data on the impact of discrimination on their medical education remain limited. In this cross-sectional study, we aimed to investigate the experiences of Black medical students through the Black Medical Students' Association of Canada (BMSAC). METHODS We developed a 63-item instrument around the domains of inclusion and diversity, wellness, discrimination, career advancement and diversity in medical education. The anonymous web-based questionnaire was sent to 128 medical students and first-year residents from all 17 Canadian medical schools via the BMSAC listserv. We obtained frequencies for demographic data and self-reported experiences. RESULTS We received 52 responses. Of respondents, 59% had at least 1 personal encounter with discrimination in medical school. Discrimination was experienced in both clinical and academic contexts, notably from patients, peers and hospital staff. Students further along in their medical training were more likely to endorse having experienced discrimination in medical school. Most respondents had positive experiences with academic and clinical inclusion, as well as resiliency in the face of discrimination. However, most respondents had negative experiences relating to reporting discrimination, their well-being, career advancement, sentiments of minority tax and low diversity in medical education. INTERPRETATION We found that discrimination has important implications on the learning experiences of Black medical students surveyed from the BMSAC. This directly challenges the notion that Canadian medical schools are impervious to racism and highlights the need for advocacy and systemic changes to eliminate institutional racism.
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Affiliation(s)
- Johanne Mathieu
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont.
| | - Salomon Fotsing
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kikelomo Akinbobola
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Lolade Shipeolu
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kien Crosse
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Kimberley Thomas
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Manon Denis-LeBlanc
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Abdoulaye Gueye
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont
| | - Gaelle Bekolo
- Faculty of Medicine (Mathieu, Akinbobola, Shipeolu, Crosse), University of Ottawa, Ottawa, Ont.; Department of Psychiatry (Mathieu), Queen's University, Kingston, Ont.; Department of Family Medicine (Fotsing) and Faculty of Medicine (Fotsing, Denis-LeBlanc), University of Ottawa, Ottawa, Ont.; Royal Columbian Hospital (Akinbobola), New Westminster, BC; Department of Obstetrics & Gynaecology (Shipeolu), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Psychiatry (Crosse), University of Toronto, Toronto, Ont.; Faculty of Medicine (Thomas), University of British Columbia; Black Medical Students' Association of Canada (Thomas), Vancouver, BC; Institut du Savoir Montfort (Denis-LeBlanc); School of Sociological and Anthropological Studies (Gueye), University of Ottawa; Department of Family Medicine (Bekolo), Montfort Hospital; Department of Undergraduate Medical Education (Bekolo), University of Ottawa, Ottawa, Ont.
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Lindsay S, Fuentes K, Ragunathan S, Lamaj L, Dyson J. Ableism within health care professions: a systematic review of the experiences and impact of discrimination against health care providers with disabilities. Disabil Rehabil 2022:1-17. [PMID: 35940208 DOI: 10.1080/09638288.2022.2107086] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE People with disabilities experience concerning rates of ableism and are significantly under-represented within healthcare education and professions. Focusing on healthcare professions is important for enhancing the diversity and inclusion of equity-deserving groups within the workforce. The objective of this review was to explore the experiences and impact of workplace discrimination and ableism among healthcare providers and trainees with disabilities. METHODS Systematic searches of seven databases from 2000 to January 2022 were conducted. Five reviewers independently applied the inclusion criteria, extracted the data and rated the study quality. RESULTS 48 studies met our inclusion criteria, representing 13,815 participants across six countries over a 21-year period. The findings highlighted rates and types of workplace ableism, which occurred at the institutional (i.e., inaccessible environments, physical barriers and unsupportive work environments) and individual level (i.e., negative attitudes, bullying, harassment). The impact of ableism on healthcare providers included difficulty disclosing due to fear of stigma, and effects on well-being and career development. CONCLUSIONS Our findings revealed a critical need for more research on the experiences of ableism amongst healthcare providers and the impact it has on their well-being. Further efforts should explore mechanisms for including and welcoming people with disabilities in healthcare professions.Implications for rehabilitationWorkplace ableism is prevalent in health care professions and could be discouraging people with disabilities from entering or completing health care education and training, leading to an under-representation of this equity-deserving group within health care.More efforts are needed to recruit, retain and support people with disabilities in the health care workforce.Health care providers who have a disability often experience workplace discrimination and inaccessible physical environments which can impact their health and well-being.Managers, senior leadership and health care organizations should advocate for improved social inclusion of employees with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sharmigaa Ragunathan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Luiza Lamaj
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Biomedical Sciences, Ryerson University, Toronto, Canada
| | - Jaclyn Dyson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Health Sciences Department, Queens University, Kingston, Canada
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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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19
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Sukhera J, Goez H, Brown A, Haddara W, Razack S. Freedom from discrimination or freedom to discriminate? Discursive tensions within discrimination policies in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:387-403. [PMID: 35025019 PMCID: PMC8757400 DOI: 10.1007/s10459-022-10090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
The importance of advancing equity, diversity, and inclusion for all members of the academic medical community has gained recent attention. Academic medical organizations have attempted to increase broader representation while seeking structural reforms consistent with the goal of enhancing equity and reducing disproportionality. However, efforts remain constrained while minority groups continue to experience discrimination. In this study, the authors sought to identify and understand the discursive effects of discrimination policies within medical education. The authors assembled an archive of 22 texts consisting of publicly available discrimination and harassment policy documents in 13 Canadian medical schools that were active as of November 2019. Each text was analysed to identify themes, rhetorical strategies, problematization, and power relations. Policies described truth statements that appear to idealize equity, yet there were discourses related to professionalism and neutrality that were in tension with these ideals. There was also tension between organizations' framing of a shared responsibility for addressing discrimination and individual responsibility on complainants. Lastly, there were also competing discourses on promoting freedom from discrimination and the concept of academic freedom. Overall, findings reveal several areas of tension that shape how discrimination is addressed in policy versus practice. Existing discourses regarding self-protection and academic freedom suggest equity cannot be advanced through policy discourse alone and more substantive structural transformation may be necessary. Existing approaches may be inadequate to address discrimination unless academic medical organizations interrogate the source of these discursive tensions and consider asymmetries of power.
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Affiliation(s)
- Javeed Sukhera
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA.
| | - Helly Goez
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences University of Alberta, Edmonton, Canada
| | - Allison Brown
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Wael Haddara
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Saleem Razack
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Paediatrics and Institute for Health Sciences Education, McGill University, Montreal, Canada
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Siad FM, Rabi DM. Harassment in the Field of Medicine: Cultural Barriers to Psychological Safety. CJC Open 2022; 3:S174-S179. [PMID: 34993446 PMCID: PMC8712706 DOI: 10.1016/j.cjco.2021.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Psychologically safe organizational cultures are inherently inclusive and promote healthy sharing of power and knowledge. These conditions allow innovation to thrive and optimize member performance. Unfortunately, despite its evidence-based nature, the field of medicine continues to struggle with providing safe environments for its members. Several cultural barriers to psychological safety permit endemic harassment. These include having large power gradients, a weak ethical climate, and a number of enabling structural factors that maintain a toxic culture. Moving toward psychological safety will be challenging work, as it requires a difficult and complex analysis of the shared value system that enables the status quo. Programs and policies that promote equity, diversity, and inclusion are an important start, but they are likely insufficient on their own to achieve psychological safety. Leadership that models difficult reflection and supports inclusive transformation is the key to a safe culture shift.
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Affiliation(s)
- Fartoon M Siad
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Doreen M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Science Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Krstić C, Krstić L, Tulloch A, Agius S, Warren A, Doody GA. The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review. MEDICAL TEACHER 2021; 43:1044-1053. [PMID: 33861176 DOI: 10.1080/0142159x.2021.1908976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both 'traditional' and WP students.Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings.Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with 'traditional' medical student peers, WP students form strong relationships with students from similar backgrounds.Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution.
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Affiliation(s)
- Courtney Krstić
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Lazar Krstić
- School of Medicine, University of Nottingham, Nottingham, UK
| | - André Tulloch
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Stevie Agius
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Alistair Warren
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Gillian A Doody
- School of Medicine, University of Nottingham, Nottingham, UK
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Deng M, Nham E, Malvea A, Ramsay T, Seabrook C, Watterson J. Exploring the Impact of the Surgical Exploration and Discovery (SEAD) Program on Medical Students' Perceptions of Gender Biases in Surgery: A Mixed-Method Evaluation. JOURNAL OF SURGICAL EDUCATION 2021; 78:1236-1249. [PMID: 33293258 DOI: 10.1016/j.jsurg.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Female representation in surgery is increasing; however, many surgical specialties continue to observe disproportionately fewer females entering their residencies. This study assesses how medical students' gender-based perceptions of surgical careers are impacted by attending the Surgical Exploration and Discovery (SEAD) program, a 2-week, immersive procedural program that offers observerships, mentorship, and workshops across 8 surgical specialties. DESIGN In this mixed-method prospective cohort study, medical students' awareness, beliefs, and experiences of gender bias in surgery were assessed using a 10-item Gender Bias in Medical Students Assessment-Surgery (GBMSA-S) psychometric survey instrument inspired by the validated Gender Bias in Medical Education Scale (Parker et al., 2016). SETTING Undergraduate Medical Education, Faculty of Medicine, at the University of Ottawa in Ottawa, Ontario, Canada. PARTICIPANTS Eighteen first-year medical students in the experimental group (8 male, 10 female) and 18 in the control group (7 male, 11 female). RESULTS Compared to the control group, SEAD participants had significant changes in agreement with the statements: "surgery is male-dominated," "medical studies are mainly done in males," "gender discrimination is more pronounced in surgery than other medical professions," "consideration of my gender is an important factor in whether or not to pursue surgery as a career," and "I have encountered gender-biased attitudes and/or behaviors among non-physician health care staff" (p < 0.05). Perceptions of gender bias were reduced post-SEAD. Subgroup analysis by gender suggested that the significance of these changing perspectives was due to female participants' responses. SEAD also produced an increase in the level of interest in surgery (p = 0.04). Receptive and authentic dialogue was identified as a critical step toward social inclusivity (n = 11). CONCLUSIONS Early surgical exposure through SEAD produces a statistically significant increase in surgical interest and reduces certain perceptions of gender bias in surgery, particularly among female medical students.
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Affiliation(s)
- Mimi Deng
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Emily Nham
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anahita Malvea
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Seabrook
- University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - James Watterson
- Department of Surgery, Eric C. Poulin Office of Surgical Education at University of Ottawa, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Urology, Department of Surgery, The Ottawa Hospital - General Campus, Ottawa, Ontario, Canada
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Yaghmour A, Alesa A, Anbarserry E, Abdullah Binmerdah M, Alharbi A, Housawi A, Almehdar M, Lytra H, Alsaywid B, Lytras DM. Challenges and Obstacles Faced by Trainee Female Physicians: An Integrative Research on Gender Discrimination, Stress, Depression and Harassment. Healthcare (Basel) 2021; 9:160. [PMID: 33546188 PMCID: PMC7913154 DOI: 10.3390/healthcare9020160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022] Open
Abstract
This study's purpose is to assess the challenges and obstacles faced by female trainee physicians and suggest solutions that could resolve these issues and improve their performance. The study utilized an observational, analytical, cross-sectional design based on a self-administered open-ended and validated questionnaire which was distributed to 133 recruited female resident trainees of medical units in Jeddah, Saudi Arabia. The findings of the study revealed that 52% female trainees experienced gender discrimination, mostly (65%) by their superiors, while 40% were regularly harassed. About half (53%) of the interviewees were severely depressed, resulting in their reconsidering their career in medicine. A total of 14% thought of suicide, while four planned to end and five had attempted to end their life. However, only eight (6%) participants officially reported the cases of harassment to the accountable superiors. Half of them felt neglected by the healthcare administration, and one-fourth (24%) were underachieving in their studies and work. The study concluded that work dissatisfaction, limited clinical correspondence, high depression, burnout, stress and drop-out rates-all deriving from common gender discrimination-compose the alarming and complex challenges that female trainee residents in Jeddah of various levels and specialties have to face.
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Affiliation(s)
- Aisha Yaghmour
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Alaa Alesa
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Esraa Anbarserry
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Merihan Abdullah Binmerdah
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
| | - Ahlam Alharbi
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Abdulrahman Housawi
- Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia; (A.H.); (M.A.)
| | - Manal Almehdar
- Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia; (A.H.); (M.A.)
| | - Hara Lytra
- School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Basim Alsaywid
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.Y.); (A.A.); (E.A.); (M.A.B.)
- Planning and Organizational Excellence Administration, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia; (A.H.); (M.A.)
- Urology Section, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard, Jeddah 11173, Saudi Arabia
| | - Dimitrios M. Lytras
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Ali K, McColl E, Tredwin C, Hanks S, Coelho C, Witton R. Addressing racial inequalities in dental education: decolonising the dental curricula. Br Dent J 2021; 230:165-169. [PMID: 33574542 PMCID: PMC7877507 DOI: 10.1038/s41415-020-2598-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/16/2020] [Indexed: 11/08/2022]
Abstract
The aim of this paper is to highlight the impact of racial disparities on the educational experiences of Black and minority ethnic students in healthcare education. Attainment gaps and barriers to career progression for minority ethnic home students in the United Kingdom have been recognised for decades, but little progress has been made to address these issues. Students and staff in higher education have been campaigning for 'decolonisation of the curriculum' to improve inclusivity and representation. These trends are being mirrored in medical education and there is growing recognition to decolonise the medical curricula. This would improve the educational experience and attainment of minority ethnic students and doctors, and would also help to address disparities in healthcare provision for minority ethnic patients. The context for decolonisation of the dental curricula is provided, followed by a discussion on the benefits, challenges and strategies for such decolonisation.
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Affiliation(s)
- Kamran Ali
- University of Plymouth, Peninsula Dental School, C504 Portland Square, Plymouth, PL4 8AA, Devon, UK.
| | | | - Christopher Tredwin
- University of Plymouth, Peninsula Dental School, The John Bull Building, Plymouth Science Park, Plymouth, PL6 8BU, Devon, UK
| | - Sally Hanks
- University of Plymouth, Peninsula Dental School, The John Bull Building, Plymouth Science Park, Plymouth, PL6 8BU, Devon, UK
| | - Catherine Coelho
- University of Plymouth, Peninsula Dental School, C504 Portland Square, Plymouth, PL4 8AA, Devon, UK
| | - Robert Witton
- Plymouth University Schools of Medicine and Dentistry, Social Engagement and Community-Based Dentistry, The John Bull Building, Plymouth Science Park, Plymouth, PL6 8BU, Devon, UK
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Suárez DE, Cardozo AC, Villarreal ME, Trujillo EM. Non-Heterosexual Medical Students Are Critically Vulnerable to Mental Health Risks: The Need to Account for Sexual Diversity in Wellness Initiatives. TEACHING AND LEARNING IN MEDICINE 2021; 33:1-9. [PMID: 32856468 DOI: 10.1080/10401334.2020.1805324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Mental health problems among medical students are a worrisome issue; recent studies have shown that one-third may be suffering major depressive disorder and one out of ten had suicidal ideation. Few studies have evaluated the association of medical students' mental health and their sexual orientation. This study aimed to evaluate differences in mental health indicators among medical students with diverse sexual orientations at a South American medical school. Approach: This study is a secondary analysis of cross-sectional data obtained through an electronic survey. The survey assessed demographics, academic variables, and several mental health scales and indexes, including: World Health Organization Well-being Index, Satisfaction With Life Scale, Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve), Self-Reporting Questionnaire, Athens Insomnia Scale, Eating Attitudes Test, and Alcohol Use Disorders Identification Test. Sexual orientation was assessed using self-identification and responses dichotomized as heterosexual and non-heterosexual. Findings: 554 students completed the survey (response rate: 70%). Mean age was 20.6 years, and the sample was 58.7% women. Eighty-two participants (14.8%) self-identified as non-heterosexual; this group comprised mostly males, fewer of whom lived with their family, and more of whom used loans or scholarships to pay university tuition fees. After adjustment for sex and tuition fee payment, non-heterosexual orientation was significantly associated (adjusted Odds Ratios [aOR] above 3.00) with rating mental health as bad, self-perceiving a need for mental health evaluation/treatment, and reporting last-year use of psychiatric medication. Lastly, non-heterosexual respondents reported more frequent psychiatric symptoms (depression/anxiety scores, suicidal ideation, eating disorder symptoms and substance use) with an aOR between 2.17 and 2.51. Insights: This study suggests that self-identified non-heterosexual medical students exhibit worse mental health outcomes evaluated through validated self-report scales and subjective perception of mental health status. This report specifically indicates that non-heterosexual medical students report family dysfunction more often and have less social support, which serve as additional risk factors. Future studies must assess social support, clarify the impact of family and peer support in mental health problems, and explore students' views on their sexual identity and the burden imposed by experiences of discrimination.
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Affiliation(s)
- Daniel E Suárez
- School of Medicine, Universidad de los Andes, Bogota, Colombia
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Kisiel MA, Kühner S, Stolare K, Lampa E, Wohlin M, Johnston N, Rask-Andersen A. Medical students' self-reported gender discrimination and sexual harassment over time. BMC MEDICAL EDUCATION 2020; 20:503. [PMID: 33302936 PMCID: PMC7731624 DOI: 10.1186/s12909-020-02422-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/03/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Gender discrimination (GD) and sexual harassment (SH) occur at all academic institutions worldwide. Medical students report high prevalence of GD and SH, which may negatively affect their education and health. There are indications that policies and reforms on reducing GD/SH are insufficient. Swedish medical students' experiences of GD/SH are monitored by course-evaluations and bi-annual student union evaluations; however, the response rate is usually low. The aim of this study was to compare the exposure to and context of self-reported GD/SH over an 11-year period amongst medical students at a Swedish university. METHODS In 2002, a questionnaire (n = 622) was mailed to medical students' home addresses. It was repeated in 2013 and then distributed during mandatory lectures (n = 856). The questions used a behavioristic approach and asked about specific GH/SH experiences. Participation was voluntary and anonymous. The changes in prevalence over time were calculated by sampling weights in order to obtain comparable estimates, representative of both cohorts. RESULTS The response frequency was 55% (62% women) in 2002 and 81% (59% women) in 2013. The prevalence of GD tended to decrease for male and clinical students in comparison to female and pre-clinical peers. However, the prevalence of SH increased for female compared to male students. The ratio of SH for female pre-clinical students doubled in many instances; most often, the mistreatment occurred in the clinic. Medical doctors were indicated as perpetrators up to five times more often by all students in 2013. CONCLUSION Our results show a disproportional change in exposure to GD/SH between female and male medical students, resulting in a widening of the gender gap regarding prevalence of GD and SH between 2002 and 2013. In particular, personal experiences of SH increased for both sexes. It is proof that institutional efforts to fight mistreatment might be ineffective.
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Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden.
| | - Sofia Kühner
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Stolare
- Department of Psychiatry, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nina Johnston
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Anna Rask-Andersen
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden
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Mateo CM, Williams DR. More Than Words: A Vision to Address Bias and Reduce Discrimination in the Health Professions Learning Environment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S169-S177. [PMID: 32889917 DOI: 10.1097/acm.0000000000003684] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Bias and discrimination are embedded within the history, norms, and practices of the health professions institution, and their negative impacts are pervasive in the health professions learning environment. These forces impair the ability to take care of patients, recruit and support diverse health care providers, and prepare the next generation of clinicians for practice. Fortunately, there are effective interventions and strategies for addressing bias and discrimination within learning environments and to both prevent and ameliorate their negative effects. This Perspective lays out a vision for health professions learning environments that are free from bias and discrimination and makes 5 recommendations, with supporting actions, that will help the leaders of health care institutions achieve this goal.
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Affiliation(s)
- Camila M Mateo
- C.M. Mateo is associate director, anti-racism curriculum and faculty development and instructor of pediatrics, Harvard Medical School, and attending physician, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - David R Williams
- D.R. Williams is the Florence Sprague Norman and Laura Stuart Norman professor of public health and chair, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and professor of African and African American studies, Harvard University, Cambridge, Massachusetts
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Mateo CM, Williams DR. Addressing Bias and Reducing Discrimination: The Professional Responsibility of Health Care Providers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S5-S10. [PMID: 32889919 DOI: 10.1097/acm.0000000000003683] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The prevalence of harmful bias and discrimination within the health professions is staggering. Moreover, literature consistently demonstrates their persistence and their negative impact on patient care. Several professional codes of conduct for health professionals highlight the importance of addressing these forces in practice. However, despite this, these forces are often discussed as tangential within health professions curricula. This paper examines the prevalence of bias and discrimination, its effects on patient care and health professions trainees, and reviews the historical context of societal bias and discrimination within the health professions institution. The authors argue that addressing harmful bias and discrimination is the professional responsibility of every provider and essential to effective and equitable care.
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Affiliation(s)
- Camila M Mateo
- C.M. Mateo is associate director, anti-racism curriculum and faculty development and instructor of pediatrics, Harvard Medical School, and attending physician, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - David R Williams
- D.R. Williams is the Florence Sprague Norman and Laura Stuart Norman professor of Public Health and chair, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and professor of African and African American studies, Harvard University, Cambridge, Massachusetts
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Roh H, Yune SJ, Park KH, Lee GH, Jung SS, Chun KH. Negative school experiences of Late Millennial Korean medical students: a qualitative study using the critical incident technique. KOREAN JOURNAL OF MEDICAL EDUCATION 2020; 32:197-211. [PMID: 32723986 PMCID: PMC7481051 DOI: 10.3946/kjme.2020.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/10/2020] [Accepted: 06/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Today's students have distinctive generational characteristics and increased psychopathology and generational tension. The authors investigated the negative experiences of Late Millennial students in medical school to draw implications for student support. METHODS The authors explored medical students' negative experiences using the critical incident technique. The authors conducted semi-structured in-depth interviews with 13 medical students, between February and May 2016. The authors focused on occurrences that significantly influenced medical students' school lives negatively from the students' perspective. All interviews were recorded and transcribed. The authors classified incidents into frames of reference for the use of faculty development for student support. RESULTS The authors extracted 22 themes from a total 334 codes and classified them into eight subcategories. Finally, four categories emerged from frames of reference. Students manipulate relationships and colluding for better specialty choice. They experience uncontrolled rifts in interpersonal relationships between peers including lawsuits, sexual assaults, and social network service conflicts. Today's students feel resentment towards dependent hierarchical relationships with seniors. They struggle with gender discrimination but perpetuate outdated gender role toward the opposite gender. CONCLUSION Faculty members should understand today's students' level of career stress and desire for work life balance. They should motivate students' professional identity, promote assertiveness against unfair authorities, and focus on mental health, teamwork, and relationship building. All generations need to understand other generations and develop appropriate leadership and gender sensitivity.
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Affiliation(s)
- HyeRin Roh
- Department of Medical Education, Inje University College of Medicine, Busan, Korea
| | - So Jung Yune
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Korea
| | - Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, Korea
| | - Geon Ho Lee
- Department of Family Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sung Soo Jung
- Department of Medical Education, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung Hee Chun
- Department of Medical Education, Konyang University College of Medicine, Daejeon, Korea
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Mann S, Ariyanayagam D. Gender bias in medical education: Stop treating it as an inevitability. MEDICAL EDUCATION 2020; 54:863. [PMID: 32324942 DOI: 10.1111/medu.14186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Simran Mann
- Faculty of Medicine, Imperial College London, London, UK
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Salazar O, Rho YU. Combating Discrimination in Medical Education. JAMA Intern Med 2020; 180:1029-1030. [PMID: 32478798 DOI: 10.1001/jamainternmed.2020.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Oliver Salazar
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Yean Uk Rho
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
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Mohsin M, Syed J. The missing doctors — An analysis of educated women and female domesticity in Pakistan. GENDER WORK AND ORGANIZATION 2020. [DOI: 10.1111/gwao.12444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mariam Mohsin
- Suleman Dawood School of Business Lahore University of Management Sciences Pakistan
| | - Jawad Syed
- Suleman Dawood School of Business Lahore University of Management Sciences Pakistan
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Bahji A, Altomare J. Prevalence of intimidation, harassment, and discrimination among resident physicians: a systematic review and meta-analysis. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e97-e123. [PMID: 32215147 PMCID: PMC7082478 DOI: 10.36834/cmej.57019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND The aim of this study was to establish the prevalence of intimidation, harassment, and discrimination (IHD) reported by resident physicians during their training, to identify factors associated with reported IHD, and to identify adverse sequalae associated with IHD. METHODS This review followed the PRISMA guidelines. Eight electronic databases were searched for cross-sectional studies reporting the prevalence of IHD among resident physicians. Prevalence estimates were pooledacross studies using random-effects meta-analysis, with variance stabilization using Tukey double arcsine transformation. Heterogeneity was assessed with forest plots, the I 2 statistic, subgroup analyses, and multivariate meta-regression. RESULTS 52 cross-sectional studies were included in the meta-analysis. The overall pooled prevalence of IHD was 64.1% (95% confidence interval [CI], 51.0-77.1). Verbal, physical, and sexual IHD were the most common forms of IHD reported by residents. Training status (55.5%), gender (41.7%), and ethnicity (20.6%) were the most commonly cited risk factors for IHD. The most common sources of IHD were relatives/friends of patients, nurses, and patients (cited by 50.7%, 47.8, and 41.7%, respectively). CONCLUSIONS The prevalence of IHD among resident physicians is high and associated with multiple negative outcomes, including burnout. Despite the availability of multiple anti-IHD interventions, reports of IHD appear to be rising in many residency programs.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen’s University, Ontario, Canada
- Department of Public Health Sciences, Queen’s University, Ontario, Canada
- Correspondence: Anees Bahji, MC PGY5, Department of Psychiatry, Queen’s UniversityMSc Candidate, Department of Public Health Sciences, Queen’s University, Abramsky Hall, Room 328, 21 Arch Street,Kingston, ON, Canada K7L 3N6; tel: 613 533-6000 ext. 33355; fax: 613 533-6388;
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Alwazzan L. Conceptualising discrimination in medical education: the hierarchy, the power. MEDICAL EDUCATION 2018; 52:356-358. [PMID: 29574963 DOI: 10.1111/medu.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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