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Prathivadi P, MacPherson N. Supporting intersectional mentoring of women in medicine. Med J Aust 2024; 221:83-85. [PMID: 38859653 DOI: 10.5694/mja2.52358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Pallavi Prathivadi
- Equity, Primary Care, Implementation and Community (EPIC) Research Unit, Monash University, Melbourne, VIC
| | - Naomi MacPherson
- Equity, Primary Care, Implementation and Community (EPIC) Research Unit, Monash University, Melbourne, VIC
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Mawdsley A, Magola-Makina E, Willis SC. Towards addressing the awarding gap-Using critical race theory to contextualise the role of intersectionality in Black pharmacy student attainment. MEDICAL EDUCATION 2024. [PMID: 38938192 DOI: 10.1111/medu.15460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/01/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The awarding gap between White and Black students in UK health curricula is well established. Critical race theory (CRT) is a lens to deconstruct pedagogic practice and consider the intersectionality of Black student lived experience to provide a realist critique of the phenomenon of Whiteness in higher education and the impact this has on Black attainment. Using one UK pharmacy programme as a case study, this paper aims to explore Black lived experience as a means of problematising and disrupting structural oppressions. METHODS Sixteen Black students from one UK pharmacy degree programme were purposively recruited to the study. Love and breakup letter methodology (LBM) was used to facilitate sharing experiences of intersectionality in relation to their undergraduate education, with data thematically analysed through the lens of CRT. RESULTS Two meta-themes (identity and inclusion; and cultural capital) and four subthemes (social capital; access; family expectations; and help-seeking) were identified. The intersectionality of Black students was articulated as not possessing the social capital and the 'language' to succeed within the White structures of the curriculum. The conflict of capital and the absence of Black culture gave rise to confined help-seeking behaviours. Whilst Black students experienced equality of access to the curriculum, an absence of rights to legitimate involvement (inclusion) worked to diminish participation in the curriculum. DISCUSSION This is the first study to consider the intersectionality of Black pharmacy students in relation to academic awarding gaps and has found that oppressive educational structures marginalise and other Black experience. Black students experience the curriculum as a place where their social and cultural capital is undervalued, and as a White space where they lack the artefacts to succeed, leading to peripheral participation and detachment. The approach used in this study can be adopted across medical and health education as a means to problematise racial inequality through the exemplar of White:Black awarding gaps.
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Affiliation(s)
- Andrew Mawdsley
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | | | - Sarah C Willis
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Broks VMA, Dijk SW, Van den Broek WW, Stegers-Jager KM, Woltman AM. Self-regulated learning profiles including test anxiety linked to stress and performance: A latent profile analysis based across multiple cohorts. MEDICAL EDUCATION 2024; 58:544-555. [PMID: 38011865 DOI: 10.1111/medu.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Medical educators aim to understand why students differ in performance and stress. While performance and stress are associated with student demographics, school factors and aspects of self-regulated learning (SRL), it remains unclear how these elements interact within individuals. This multi-cohort study identified SRL profiles among medical students and explored their associations with performance and stress. Additionally, we examined the identified profiles' associations with gender, migration status and assessment policy. METHODS We used latent profile analysis (LPA) to identify profiles on Motivated Strategies for Learning Questionnaire (MSLQ) scores of six cohorts (2014-2019) of Year 1, first semester medical students (n = 1894) in a Dutch medical school. We used nine MSLQ subscales that measure test anxiety (TA), self-efficacy, deep learning, resource management and value. The university's assessment policy varied, demanding students to obtain 100% or 75% of Year 1 credits to remain enrolled. We defined optimal performance as obtaining all credits at the end of Year 1. Two cohorts completed the Perceived Stress Scale (PSS-14, n = 409) in the 2nd semester. RESULTS We identified three distinct student profiles: 693/1894(36.6%) were classified as TAhighSRLhigh, 661/1894(34.9%) as TAlowSRLhigh and 540/1894(28.5%) as TAmoderateSRLlow. Females were more likely to belong to TAhighSRLhigh profiles compared to males (effect size [ES] Cramer's V = .13, small). Migration background was not associated with these profiles. The TAhighSRLhigh profile was more prevalent under the 100% assessment policy (ES Cramer's V = .10, negligible). TAlowSRLhigh students demonstrated lower stress levels (PSS = 23.9 out of 56) compared to TAhighSRLhigh students (PSS = 28.7, ES Cohen's d = .62, medium) and TAmoderateSRLlow students (PSS = 28.2, ES Cohen's d = .51, medium). Performance differed among the three profiles (ES Cramer's V = .16, small): 82.5% optimal performance in the TAlowSRLhigh, 71.9% in the TAhighSRLhigh and 65.2% in the TAmoderateSRLlow profile. DISCUSSION Three distinct SRL student profiles associated with gender, academic performance and perceived stress were identified. Test anxiety had additional value in distinguishing subgroups with differential academic performance and stress. These profiles may aid educators to inform personalised support strategies for novice learners.
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Affiliation(s)
- Vera M A Broks
- Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Stijntje W Dijk
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Imaging, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Walter W Van den Broek
- Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Karen M Stegers-Jager
- Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Andrea M Woltman
- Institute of Medical Education Research Rotterdam, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Müller J, Meyer R, Bantjes J, Archer E, Couper I. Handle with Care: Transformative Learning as Pedagogy in an Under-Resourced Health Care Context. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38634761 DOI: 10.1080/10401334.2024.2332885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
Issue: A significant component of health professions education is focussed on students' exposure to the social determinants of health and the challenges that patients within the health care system face. An appropriate way to provide such exposure is through distributed clinical training. This usually entails students training in smaller groups along the continuum of care, away from tertiary academic hospitals. This also means students are away from their existing academic and social support systems. It is evident that knowledge and clinical skills alone are not sufficient to prepare students, they also need to be taught to critically reflect on how their own values and attitudes traverse their knowledge and skills to influence their practice as healthcare professionals. This process of critical reflection should aim to provide a transformative learning experience for students and requires active facilitation. In under-resourced health care contexts where clinicians responsible for student training are facing high patient load, lack of resources, inequitable health care services and high levels of burn-out, the facilitation of student learning may be compromised. Evidence: Clinical learning opportunities that are considered transformative, frequently challenge students' sense of self and sense of belonging. This experience can have detrimental effects if the processes of transformative learning pedagogy are not adequately facilitated. The provision of support staff, lecturers and clinical facilitators on the distributed training platform is challenged by the remote nature of some of the sites and the cost of recruiting and capacitating additional on-site staff. The potential for what has been termed "transformative trauma" and the subsequent halted transformative learning experience, has ethical implications in terms of student wellness and the educational responsibility institutions carry. Implications: The authors suggest considerations in facilitating an ethical transformative learning process. These include making the transformative learning pedagogy explicit to students and clinical facilitators and using the 'brave spaces' framework to help students with individuation and provide them with the tools to understand how emotion influences behavior. Strategies to improve relationship development and communities of support, as well as ideas for faculty development are offered.
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Affiliation(s)
- Jana Müller
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoda Meyer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elize Archer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Bullock JL, Sukhera J, Del Pino-Jones A, Dyster TG, Ilgen JS, Lockspeiser TM, Teunissen PW, Hauer KE. 'Yourself in all your forms': A grounded theory exploration of identity safety in medical students. MEDICAL EDUCATION 2024; 58:327-337. [PMID: 37517809 DOI: 10.1111/medu.15174] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Identity threats, such as stereotype threat and microaggressions, impair learning and erode well-being. In contrast to identity threat, less is known about how learners experience feelings of safety regarding their identity. This exploratory study aims to develop a theory of identity safety in the clinical learning environment. METHODS This multi-institutional, qualitative interview study was informed by constructivist grounded theory and critical pedagogy. Participants were clinical students at three public medical schools in the United States in 2022. Investigators purposively sampled participants for interviews based on their responses to an 11-item survey with an open-ended question soliciting students' personal identities and responses to both the racial/ethnic and gender Stereotype Vulnerability Scales. The investigators interviewed, coded, constantly compared and continued sampling until the codes could be developed into categories, then concepts and finally into a theory. The team engaged in critical reflexivity throughout the analytic process to enrich data interpretations. RESULTS Sixteen diverse students were interviewed. We organised their identity-salient experiences into identity threat, threat mitigation and identity safety. Participants experienced identity threat through unwelcoming learning environments, feeling compelled to change their behaviour in inauthentic ways or sociopolitical threat. Threat mitigation occurred when a participant or supervisor intervened against an identity threat, dampening but not eliminating the threat impact. Participants characterised identity safety as the ability to exist as their authentic selves without feeling the need to monitor how others perceive their identities. Identity safety manifested when participants demonstrated agency to leverage their identities for patient care, when others upheld their personhood and saw them as unique individuals and when they felt they belonged in the learning environment. DISCUSSION Attending to identity safety may lead to educational practices that sustain and leverage team members' diverse identities. Identity safety and threat mitigation may work together to combat identity threats in the learning environment.
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Affiliation(s)
- Justin L Bullock
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington, USA
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Javeed Sukhera
- Department of Psychiatry at Hartford Hospital, Institute of Living, Hartford, Connecticut, USA
| | - Amira Del Pino-Jones
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Timothy G Dyster
- School of Medicine, Division of Pulmonary, and Critical Care Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tai M Lockspeiser
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
- Maastricht University Medical Centre, Maastricht, Netherlands
| | - Karen E Hauer
- University of California, San Francisco, San Francisco, California, USA
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Nolan HA, Owen K. Medical student experiences of equality, diversity, and inclusion: content analysis of student feedback using Bronfenbrenner's ecological systems theory. BMC MEDICAL EDUCATION 2024; 24:5. [PMID: 38172809 PMCID: PMC10765790 DOI: 10.1186/s12909-023-04986-8] [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: 04/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Issues relating to equality, diversity, and inclusion (EDI) significantly impact on medical student achievement and wellbeing. Interventions have been introduced at curricular and organisational levels, yet progress in addressing these issues remains limited. Timely evaluation is needed to assess effectiveness of interventions, and to explore issues and interactions in learning environments impacting on student experience. We introduced an anonymous question concerning students' experiences of EDI into routine online student feedback questionnaires, to scope the nature of ongoing issues and develop greater understanding of students' experiences in our programme environment. Ecological systems theory, which conceptualizes learning as a function of complex social interactions, determined by characteristics of individual learners and their environment, provides a framework for understanding. METHODS Free-text responses regarding experiences of EDI gathered over 20 months from all programme years (n = 760) were pooled for analysis, providing a holistic overview of experiences in the learning environment. A counting exercise identified broad categories reported by students. Content analysis of the qualitative dataset was undertaken. Bronfenbrenner's ecological systems theory was applied as a framework to demonstrate interdependencies between respondents' experiences and environments, and associated impacts. RESULTS Three hundred and seventy-six responses were received relating to wide-ranging EDI issues, most frequently gender or ethnicity. Responses mapped onto all areas of the ecological systems model, with frequent links between subsystems, indicating considerable complexity and interdependencies. Interpersonal interactions and associated impacts like exclusion were frequently discussed. Differential experiences of EDI-related issues in medical school compared to clinical settings were reported. Impacts of institutional leadership and wider societal norms were considered by respondents. Respondents discussed their need for awareness of EDI with reference to future professional practice. CONCLUSIONS Implementation of a regular free-text evaluation question allowed data-gathering across cohorts and throughout several stages of the curriculum, illuminating student experience. Connections established demonstrated intersectionality, and how environment and other factors interact, impacting on student experiences. Students experience EDI-related issues on multiple levels within the educational environment, with consequent impacts on learning. Any successful approach towards tackling issues and promoting equity of opportunity for all requires multi-level actions and widespread culture change. Students can offer fresh and distinct perspectives regarding change needed, to complement and diversify perspectives provided by staff and organisational leadership. Student voice should be enabled to shape change.
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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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Hayashi M, Breugelmans R, Nishiya K. Identity conflicts of student affairs officers in a medical university. MEDICAL EDUCATION ONLINE 2023; 28:2182216. [PMID: 36840965 PMCID: PMC9970241 DOI: 10.1080/10872981.2023.2182216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/24/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Collaboration between student affairs officers and the faculty is important in dealing with the recent rapid changes in medical education, and mutual understanding is essential to ensure that participants become a cohesive social group. This study explores the identity conflicts of student affairs officers in medical universities using the figured worlds theory. METHODS An exploratory qualitative case study was conducted with 24 student affairs officers at a private medical university in Japan. Data were collected through face-to-face, semi-structured interviews and analysed using thematic analysis from the perspective of a social constructivism paradigm. RESULTS Qualitative analysis revealed the following three themes regarding the identity conflicts of student affairs officers: differences in the perception of medical students, difficulties in building trusting relationships with the faculty, and resistance to the medical university's traditional atmosphere. Student affairs officers tended to provide support from a student-centred perspective when interacting with medical students, while the faculty employed a teacher-centred perspective. DISCUSSION To promote understanding between professions, it is necessary to set aside certain professional views and welcome dialogue with other professionals with different values, while also understanding the multi-layered context of medical education, so that conflicts can be handled optimally and relationships can be professionalised for social cohesion.
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Affiliation(s)
- Mikio Hayashi
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
- Master of Medical Sciences in Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Katsumi Nishiya
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
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Hauer KE, Park YS, Bullock JL, Tekian A. "My Assessments Are Biased!" Measurement and Sociocultural Approaches to Achieve Fairness in Assessment in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S16-S27. [PMID: 37094278 DOI: 10.1097/acm.0000000000005245] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Assessing learners is foundational to their training and developmental growth throughout the medical education continuum. However, growing evidence shows the prevalence and impact of harmful bias in assessments in medical education, accelerating the urgency to identify solutions. Assessment bias presents a critical problem for all stages of learning and the broader educational system. Bias poses significant challenges to learners, disrupts the learning environment, and threatens the pathway and transition of learners into health professionals. While the topic of assessment bias has been examined within the context of measurement literature, limited guidance and solutions exist for learners in medical education, particularly in the clinical environment. This article presents an overview of assessment bias, focusing on clinical learners. A definition of bias and its manifestations in assessments are presented. Consequences of assessment bias are discussed within the contexts of validity and fairness and their impact on learners, patients/caregivers, and the broader field of medicine. Messick's unified validity framework is used to contextualize assessment bias; in addition, perspectives from sociocultural contexts are incorporated into the discussion to elaborate the nuanced implications in the clinical training environment. Discussions of these topics are conceptualized within the literature and the interventions used to date. The article concludes with practical recommendations to overcome bias and to develop an ideal assessment system. Recommendations address articulating values to guide assessment, designing assessment to foster learning and outcomes, attending to assessment procedures, promoting continuous quality improvement of assessment, and fostering equitable learning and assessment environments.
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Affiliation(s)
- Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards, and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8812-4045
| | - Yoon Soo Park
- Y.S. Park is associate professor and associate head, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Justin L Bullock
- J.L. Bullock is a fellow, Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Seattle, Washington; ORCID: http://orcid.org/0000-0003-4240-9798
| | - Ara Tekian
- A. Tekian is professor and associate dean for international education, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-9252-1588
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Weßel M, Gerhards SM. "Discrimination is always intersectional" - understanding structural racism and teaching intersectionality in medical education in Germany. BMC MEDICAL EDUCATION 2023; 23:399. [PMID: 37268929 DOI: 10.1186/s12909-023-04386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Racism in medicine represents a global problem. It takes place on the individual, institutional and structural level. Especially structural racism can have serious effects on the health of individual people. Furthermore, racist discrimination is not always based on race solemnly but frequently intersects with other social categories such as gender, class or religion. To describe this multidimensional form of discrimination the term intersectionality has been coined. However, the understanding of structural intersectional racism in medicine is still fragmented, especially in the German context. Yet, medical students need to be trained in understanding structural and intersectional racism to see the impact of racist structures on the patient's health. METHOD We conducted a qualitative study to explore the knowledge, awareness and perception of racism in medicine and health care of medical students in Germany. Our research questions are how do medical student understand structural racism and its effects on health in Germany? Do students see interrelations with other forms of discrimination and in this context to what extent are they familiar with the concept of intersectionality? Which categories intersect from their point of views with race in context of medicine and health care? We conducted focus groups with medical students (n = 32) in Germany. RESULTS Our results demonstrate that students have a wide spectrum of knowledge, awareness and perceptions about racism from being rather elaborate to very little knowledge about it. The students have particular problems to understand and situate structural racism in Germany. Some raised doubts about the relevance. Yet, other students are aware of the concept of intersectionality and are convinced that racism must be looked at from an intersectional perspective. CONCLUSIONS The diverse knowledge, awareness and perceptions of medical students about structural racism and intersectionality hints to a lack of systematic education of medical students about these issues in Germany. Yet, in context of diversifying societies an understanding about racism and its impact on health is imminent for future medical doctors to provide good care for their patients. Therefore, this knowledge gap must be systematically filled by the medical education.
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Affiliation(s)
- Merle Weßel
- Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26111, Oldenburg, Germany.
| | - Simon Matteo Gerhards
- Ethics in Medicine, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26111, Oldenburg, Germany
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Mawdsley A, Willis SC. Hetero- and cisnormativity-UK pharmacy education as a queer opponent. MEDICAL EDUCATION 2023; 57:574-586. [PMID: 36633540 DOI: 10.1111/medu.15018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Queer pedagogy is a lens through which the hegemonic discourses of curricula and the heterosexual assumptions within them can be made visible. Using this lens, sexuality and gender norms incorporated in undergraduate medical and health curricula can be located and the lived experience of a curriculum examined. This paper seeks to determine the extent of hetero/cisnormativity within UK pharmacy education with the aim of problematising the normalisation of heterosexuality; following this, strategies to disrupt structured hetero/cisnormativity are considered. METHODS Online cross-sectional surveys were distributed to course leads (n = 29) and students enrolled on undergraduate pharmacy (MPharm) programmes. Surveys captured quantitative data on curriculum design and perceived barriers to implementation of inclusive curriculum design (the espoused LGBTQI+ curriculum), as well qualitative data on the lived experience of the hidden curriculum. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed thematically. RESULTS Responses were received from 19 course leads and students from 25 MPharm programmes, representing varying completion rates. Findings suggest the shared values and goals of pharmacy education act to normalise and legitimise hetero and cis identities within curriculum design that othering as a consequence of heterosexual normativity is experienced and that pharmacy education is an LGBTQI+ opponent and does not adopt an ally attitude. Moreover, both educator and student data suggest that the enacted and experienced curriculum fails to prepare learners to care for LGBTQI+ people. DISCUSSION Despite findings suggesting the espoused or enacted curriculum absents LGBTQI+ people, and the hidden curriculum is experienced as homonegative, learners are questioning, resisting and disrupting the hetero- and cisnormative benevolent heterosexism within UK pharmacy curricula. This method of curricula interrogation can be adopted across health professions education as a means for ongoing problematising and disruption of normativity in clinical education.
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Affiliation(s)
- Andrew Mawdsley
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Sarah C Willis
- Management and Policy Division Alliance Manchester Business School, University of Manchester, Manchester, UK
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Richardson CL, Filan J, Lindsey L, Mundell A, Rathbone AP, Nazar H. Intersectional Identities: Making Sense of Skill Development on Clinical Placements. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100050. [PMID: 37288692 DOI: 10.1016/j.ajpe.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/29/2022] [Accepted: 01/11/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.
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Affiliation(s)
- Charlotte Lucy Richardson
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom.
| | - Jack Filan
- Newcastle University, Faculty of Medical Sciences, School of Medical Education, Newcastle upon Tyne, United Kingdom
| | - Laura Lindsey
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
| | - Amy Mundell
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Adam Pattison Rathbone
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
| | - Hamde Nazar
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
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Bajwa NM, Sader J, Kim S, Park YS, Nendaz MR, Bochatay N. Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration. PLoS One 2023; 18:e0280564. [PMID: 36800365 PMCID: PMC9937497 DOI: 10.1371/journal.pone.0280564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/02/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Effective collaboration is the foundation for delivering safe, high quality patient care. Health sciences curricula often include interprofessional collaboration training but may neglect conflicts that occur within a profession (intraprofessional). We describe the development of and validity evidence for an assessment of intraprofessional conflict management. METHODS AND FINDINGS We designed a 22-item assessment, the Intraprofessional Conflict Exercise, to evaluate skills in managing intraprofessional conflicts based on a literature review of conflict management. Using Messick's validity framework, we collected evidence for content, response process, and internal structure during a simulated intraprofessional conflict from 2018 to 2019. We performed descriptive statistics, inter-rater reliability, Cronbach's alpha, generalizability theory, and factor analysis to gather validity evidence. Two trained faculty examiners rated 82 trainees resulting in 164 observations. Inter-rater reliability was fair, weighted kappa of 0.33 (SE = 0.03). Cronbach's alpha was 0.87. The generalizability study showed differentiation among trainees (19.7% person variance) and was highly reliable, G-coefficient 0.88, Phi-coefficient 0.88. The decision study predicted that using one rater would have high reliability, G-coefficient 0.80. Exploratory factor analysis demonstrated three factors: communication skills, recognition of limits, and demonstration of respect for others. Based on qualitative observations, we found all items to be applicable, highly relevant, and helpful in identifying how trainees managed intraprofessional conflict. CONCLUSIONS The Intraprofessional Conflict Exercise provides a useful and reliable way to evaluate intraprofessional conflict management skills. It provides meaningful and actionable feedback to trainees and may help health educators in preparing trainees to manage intraprofessional conflict.
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Affiliation(s)
- Nadia M. Bajwa
- Department of General Pediatrics at the Children’s Hospital, Geneva University Hospitals in Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Julia Sader
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Kim
- Department of Surgery, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Yoon Soo Park
- MGH Institute of Health Professions at Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mathieu R. Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Naïke Bochatay
- Department of Pediatrics at the University of California, San Francisco, San Francisco, California, United States of America
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Kerins J, Smith SE, Tallentire VR. 'Us versus them': A social identity perspective of internal medicine trainees. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:341-349. [PMID: 36478526 PMCID: PMC9734785 DOI: 10.1007/s40037-022-00733-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Silos and group boundaries in the clinical workplace can result in interprofessional conflict which can be a source of anxiety for doctors in training. The social identity perspective (SIP) incorporates theories of social identity and self-categorisation, and may provide a useful lens to understand the socialisation and identity development of doctors. This study aimed to determine if and how the SIP may provide insight into intergroup relations as experienced by internal medicine (IM) trainees in Scotland. METHODS Interprofessional communication workshops hosted as part of an IM boot camp between August 2020 and March 2021 were audio recorded and transcribed verbatim. Subsequent individual interviews with consenting trainees further explored social identity and intergroup relations. Data analysis employed template analysis and deductive independent coding with the SIP informing the initial coding template and new codes added inductively. RESULTS Seventeen workshops, involving 100 trainees, and ten subsequent individual interviews were included. Trainees related to the social identity of an IM doctor and to stereotypes within the workplace. They described intergroup tensions resulting from a perception of differing priorities. They experienced outgroup derogation and the impact of role modelling those in their social group during their identity development. DISCUSSION The SIP provides a useful lens to understand the social phenomena at play for IM trainees. It confirms the expectation of conflict between specialties and negative perceptions of outgroups. There is a need to consider the hidden curriculum of socialisation in the workplace during training and the influence of the learning environment on identity development.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK.
- NHS Greater Glasgow and Clyde, Glasgow, UK.
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Lothian, Edinburgh, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
- NHS Lothian, Edinburgh, UK
- NHS Education for Scotland, Edinburgh, UK
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15
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Upton J, Kassel L, Hansen A, Butler J. Examining Social Identities of Patient Diversity Through Cases Presented in a Therapeutics Course Series. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8706. [PMID: 34862176 PMCID: PMC10159468 DOI: 10.5688/ajpe8706] [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: 04/21/2021] [Accepted: 11/29/2021] [Indexed: 05/06/2023]
Abstract
Objective. In pharmacy education, considerable debate surrounds the decision about whether didactic cases should include social identities, such as race, ethnicity, sexual orientation, gender identity, ability, spirituality, nationality, and socioeconomic status. In considering what and how much of these identities to include, the first step could be to measure their current inclusion. This study aimed to quantify the presence of these social identities in cases presented to student pharmacists in a three-semester course series.Methods. One hundred forty-four cases presented in a three-semester pharmacotherapeutics course series were reviewed. The primary objective was to quantify the inclusion of each social identity. The secondary objective was to assess whether the identities were needed to answer specific questions related to each case. Cases were reviewed by two independent study researchers; a third impartial reviewer settled disagreements.Results. Cases rarely explicitly included social identities. Race was explicitly stated in 15% of cases (n = 21). Gender identity was explicitly named in two cases (1%), but nearly all cases implied gender through pronouns. Gender was necessary to answer case questions in approximately 20% of cases (n=27). Socioeconomic status, ability, sexual orientation, and nationality were infrequently named among all cases, at rates of 6%, 5%, 1%, and 1%, respectively.Conclusion. This study found that didactic cases rarely explicitly state social identities. In determining the next steps for integrating social identities, pharmacy education must first take stock of how it currently acknowledges these identities.
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Affiliation(s)
- Jesse Upton
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Lynn Kassel
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Anisa Hansen
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
| | - Jared Butler
- Drake University, College of Pharmacy and Health Sciences, Des Moines, Iowa
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Youmans QR, Maldonado M, Essien UR, Lupton K. Building Inclusion and Belonging in Training Environments. J Grad Med Educ 2022; 14:333-334. [PMID: 35754649 PMCID: PMC9200258 DOI: 10.4300/jgme-d-22-00307.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Quentin R. Youmans
- Quentin R. Youmans, MD, MSc, is a Fellow, Division of Cardiology, Northwestern University Feinberg School of Medicine, and Resident Editor, Journal of Graduate Medical Education (JGME)
| | - Maria Maldonado
- Maria Maldonado, MD, is an Adjunct Associate Professor, Icahn School of Medicine at Mount Sinai, and Associate Editor, JGME
| | - Utibe R. Essien
- Utibe R. Essien, MD, MPH, is an Assistant Professor of Medicine, University of Pittsburgh School of Medicine
| | - Katherine Lupton
- Katherine Lupton, MD, is an Associate Professor of Medicine, University of California, San Francisco
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Diallo MS, Tan JM, Heitmiller ES, Vetter TR. Achieving Greater Health Equity: An Opportunity for Anesthesiology. Anesth Analg 2022; 134:1175-1184. [PMID: 35110516 DOI: 10.1213/ane.0000000000005937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthesiology and anesthesiologists have a tremendous opportunity and responsibility to eliminate health disparities and to achieve health equity. We thus examine health disparity and health equity through the lens of anesthesiology and the perspective of anesthesiologists. In this paper, we define health disparity and health care disparities and provide tangible, representative examples of the latter in the practice of anesthesiology. We define health equity, primarily as the desired antithesis of health disparity. Finally, we propose a framework for anesthesiologists, working toward mitigating health disparity and health care disparities, advancing health equity, and documenting improvements in health care access and health outcomes. This multilevel and interdependent framework includes the perspectives of the patient, clinician, group or department, health care system, and professional societies, including medical journals. We specifically focus on the interrelated roles of social identity and social determinants of health in health outcomes. We explore the foundational role that clinical informatics and valid data collection on race and ethnicity have in achieving health equity. Our ability to ensure patient safety by considering these additional patient-specific factors that affect clinical outcomes throughout the perioperative period could substantially reduce health disparities. Finally, we explore the role of medical journals and their editorial boards in ameliorating health disparities and advancing health equity.
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Affiliation(s)
- Mofya S Diallo
- From the Division of Anesthesiology, Sedation and Perioperative Medicine, Children's National Hospital-George Washington University, Washington, DC
| | - Jonathan M Tan
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine at the University of Southern California, Spatial Sciences Institute at the University of Southern California, Los Angeles, California
| | - Eugenie S Heitmiller
- Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital-George Washington University, Washington, DC
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
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Brown MEL, Horsburgh J. I and thou: Challenging the barriers to adopting a relational approach to medical education. MEDICAL EDUCATION 2022; 56:14-16. [PMID: 34761420 DOI: 10.1111/medu.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
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Wozniak H, Philip RL. Imagining the future: Social connections and new methodologies. MEDICAL EDUCATION 2022; 56:10-13. [PMID: 34761416 DOI: 10.1111/medu.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Helen Wozniak
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Robyn L Philip
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Eva KW. Connections within the seemingly inevitable triad of self, social and situation. MEDICAL EDUCATION 2022; 56:2-3. [PMID: 34761428 DOI: 10.1111/medu.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Kevin W Eva
- Centre for Health Education Scholarship, University of British Columbia Medicine, Vancouver, British Columbia, Canada
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