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Sivananthajothy P, Adel A, Afhami S, Castrogiovanni N, Osei-Tutu K, Brown A. Equity, diversity, and…exclusion? A national mixed methods study of "belonging" in Canadian undergraduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:611-639. [PMID: 37563338 DOI: 10.1007/s10459-023-10265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging.
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Affiliation(s)
| | - Adibba Adel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shima Afhami
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nina Castrogiovanni
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kannin Osei-Tutu
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Allison Brown
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Albert MA, Churchwell K, Desai N, Johnson JC, Johnson MN, Khera A, Mieres JH, Rodriguez F, Velarde G, Williams DR, Wu JC. Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association. Circulation 2024; 149:e312-e329. [PMID: 38226471 DOI: 10.1161/cir.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.
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Boatright D, Nguyen M, Hill K, Berg D, Castillo-Page L, Anderson N, Agbelese V, Venkataraman S, Saha S, Schoenbaum SC, Richards R, Jordan A, Asabor E, White MA. Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools. JAMA Netw Open 2024; 7:e240001. [PMID: 38381434 PMCID: PMC10882418 DOI: 10.1001/jamanetworkopen.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/26/2023] [Indexed: 02/22/2024] Open
Abstract
Importance Creating an inclusive and equitable learning environment is a national priority. Nevertheless, data reflecting medical students' perception of the climate of equity and inclusion are limited. Objective To develop and validate an instrument to measure students' perceptions of the climate of equity and inclusion in medical school using data collected annually by the Association of American Medical Colleges (AAMC). Design, Setting, and Participants The Promoting Diversity, Group Inclusion, and Equity tool was developed in 3 stages. A Delphi panel of 9 members identified survey items from preexisting AAMC data sources. Exploratory and confirmatory factor analysis was performed on student responses to AAMC surveys to construct the tool, which underwent rigorous psychometric validation. Participants were undergraduate medical students at Liaison Committee on Medical Education-accredited medical schools in the US who completed the 2015 to 2019 AAMC Year 2 Questionnaire (Y2Q), the administrations of 2016 to 2020 AAMC Graduation Questionnaire (GQ), or both. Data were analyzed from August 2020 to November 2023. Exposures Student race and ethnicity, sex, sexual orientation, and socioeconomic status. Main Outcomes and Measures Development and psychometric validation of the tool, including construct validity, internal consistency, and criterion validity. Results Delphi panel members identified 146 survey items from the Y2Q and GQ reflecting students' perception of the climate of equity and inclusion, and responses to these survey items were obtained from 54 906 students for the Y2Q cohort (median [IQR] age, 24 [23-26] years; 29 208 [52.75%] were female, 11 389 [20.57%] were Asian, 4089 [7.39%] were multiracial, and 33 373 [60.28%] were White) and 61 998 for the GQ cohort (median [IQR] age, 27 [26-28] years; 30 793 [49.67%] were female, 13 049 [21.05%] were Asian, 4136 [6.67%] were multiracial, and 38 215 [61.64%] were White). Exploratory and confirmatory factor analyses of student responses identified 8 factors for the Y2Q model (faculty role modeling; student empowerment; student fellowship; cultural humility; faculty support for students; fostering a collaborative and safe environment; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation) and 5 factors for the GQ model (faculty role modeling; student empowerment; faculty support for students; discrimination: race, ethnicity, and gender; and discrimination: sexual orientation). Confirmatory factor analysis indicated acceptable model fit (root mean square error of approximation of 0.05 [Y2Q] and 0.06 [GQ] and comparative fit indices of 0.95 [Y2Q] and 0.94 [GQ]). Cronbach α for individual factors demonstrated internal consistency ranging from 0.69 to 0.92 (Y2Q) and 0.76 to 0.95 (GQ). Conclusions and Relevance This study found that the new tool is a reliable and psychometrically valid measure of medical students' perceptions of equity and inclusion in the learning environment.
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Affiliation(s)
- Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | | | - David Berg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | | | - Nientara Anderson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Victoria Agbelese
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Shruthi Venkataraman
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
| | - Somnath Saha
- Section of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Regina Richards
- Office of Diversity, Equity, Inclusion and Community Engagement, University of Colorado Anschutz Medical Campus, Aurora
| | - Ayana Jordan
- Department of Psychiatry, New York University Grossman School of Medicine
| | - Emmanuella Asabor
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Marney A. White
- Yale School of Medicine, New Haven, Connecticut
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
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Frizell CA, Graham D, DuVentre A, Brown SD. Embracing Neuro-Inclusivity Within Physician Assistant/Associate Education: Challenging Organizational Cultural Norms and Navigating Communication Challenges. J Physician Assist Educ 2024:01367895-990000000-00128. [PMID: 38306305 DOI: 10.1097/jpa.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT Effective communication in health care education is essential for creating an inclusive learning environment. This manuscript examines the crucial role of communication in physician assistant/associate (PA) education, particularly in the context of neurodiverse individuals, who constitute approximately 20% of the global population. A groundbreaking study by Nouri et al reveals a 3.1% overall disability prevalence among US practicing physicians, emphasizing the necessity for a comprehensive understanding of diversity in the health care profession. Considering the intersectionality of marginalized identities, this research sheds light on potential challenges health care providers face, underscoring the importance of promoting inclusivity and support for neurodiverse individuals in the PA profession. The increasing presence of neurodivergent students in postsecondary institutions, despite academic strengths, holds relevance for PA education. Recognizing the barriers and stigmas associated with neurodiversity is crucial for fostering inclusive environments within PA programs and sponsoring institutions. This manuscript explores the challenges faced by neurodiverse individuals in PA education and proposes strategies for cultivating a neuroinclusive culture through effective communication. With a focus on celebrating and using the strengths of all learners, regardless of neurodiversity, the overarching goal is to contribute to a paradigm shift in PA education, enriching the educational experience for students, educators, and support staff.
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Affiliation(s)
- Carl A Frizell
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
| | - Devin Graham
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
| | - Amber DuVentre
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
| | - Sheena D Brown
- Carl A. Frizell, DMSc, MSPAS, PA-C, is a graduate student at University of Central Arkansas, Conway, Arkansas
- Devin Graham, BA, is a graduate student at University of California, Irvine, Irvine, California
- Amber DuVentre, MS, CNP, is a member of Southern States Communication Association, Knoxville, Tennessee
- Sheena D. Brown, PhD, MSCR, is a volunteer with South College PA Program, Atlanta, Georgia
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Paris SE, Dinno A, Marr MC, Raz Link A, Lentz BL, Setthavongsack A, Espinosa SN, Shusterman G, Abel J, Harrison K, Hook J, Alvord TW, Richardson DM, Chase K, Marriott LK. Inclusive Approaches for Measuring Demographics of Underrepresented Populations in STEM and Biomedical Research Training Programs. JOURNAL OF STEM OUTREACH 2024; 7. [PMID: 39006760 PMCID: PMC11241867 DOI: 10.15695/jstem/v7i2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
As federal strategic plans prioritize increasing diversity within the biomedical workforce, and STEM training and outreach programs seek to recruit and retain students from historically underrepresented populations, there is a need for interrogation of traditional demographic descriptors and careful consideration of best practices for obtaining demographic data. To accelerate this work, equity-focused researchers and leaders from STEM programs convened to examine approaches for measuring demographic variables. Gender, race/ethnicity, disability, and disadvantaged background were prioritized given their focus by federal funding agencies. Categories of sex minority, sexual (orientation) minority, and gender minority (SSGM) should be included in demographic measures collected by STEM programs, consistent with recommendations from White House Executive Orders and federal reports. Our manuscript offers operationalized phrasing for demographic questions and recommendations for use across student-serving programs. Inclusive demographics permit the identification of individuals who are being excluded, marginalized, or improperly aggregated, increasing capacity to address inequities in biomedical research training. As trainees do not enter training programs with equal access, accommodations, or preparation, inclusive demographic measures can welcome trainees and inform a nuanced set of program outcomes that facilitate research on intersectionality to support the recruitment and retention of underrepresented students in biomedical research.
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Affiliation(s)
- S E Paris
- Oregon Health and Science University, Portland, OR
| | - A Dinno
- Portland State University, Portland, OR
| | - M C Marr
- Oregon Health and Science University, Portland, OR
| | | | - B L Lentz
- Oregon Health and Science University, Portland, OR
| | | | - S N Espinosa
- Oregon Health and Science University, Portland, OR
| | | | - J Abel
- Portland State University, Portland, OR
| | | | - J Hook
- Portland State University, Portland, OR
| | - T W Alvord
- Oregon Health and Science University, Portland, OR
| | | | - K Chase
- Oregon Health and Science University, Portland, OR
| | - L K Marriott
- Oregon Health and Science University, Portland, OR
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Geiger G, Kiel L, Horiguchi M, Martinez-Aceves C, Meza K, Christophers B, Orellana P, Pinzon MM, Lubner SJ, Florez N. Latinas in medicine: evaluating and understanding the experience of Latinas in medical education: a cross sectional survey. BMC MEDICAL EDUCATION 2024; 24:4. [PMID: 38172800 PMCID: PMC10765906 DOI: 10.1186/s12909-023-04982-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The percentage of physicians identifying as Latina has not improved despite improvements in recruitment of Latina medical students, suggesting barriers to retention and career advancement. Discriminatory experiences and mental health inflictions throughout training may contribute to difficulties in recruitment, retainment, and advancement of Hispanic/Latinx trainees, a notably understudied population. METHODS An anonymous, online survey was distributed to Latinas in the continental U.S. between June 22 to August 12, 2022. Eligibility criteria included: self-identifying as Hispanic/Latina, female/woman, and completing or have completed medical school, residency, or fellowship in the continental U.S. in the past 10 years. Recruitment was done via the Twitter account @LatinasInMed and outreach to Latino Medical Student Association chapters. Descriptive statistics summarized the self-reported experiences. RESULTS The survey included 230 Hispanic/Latinx women, mostly medical students (46.9%). A majority (54.5%) reported negative ethnicity-based interactions from patients and/or patients' families; 71.8%, from others in the medical field. High rates of depression (76.2%) and anxiety (92.6%) during training were reported by Latinas, especially medical students. Feelings of imposter syndrome and burnout were high at 90.7% and 87.4%, respectively. CONCLUSIONS This is the first study evaluating the unique experiences of Latinas in medicine, who reported discrimination and mental health struggles, specifically during medical school, at alarmingly high rates. Our findings could aid in creating the needed interventions to support Latinas in medical training to reduce the existing exodus of Latinas from medicine.
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Affiliation(s)
- Gabriella Geiger
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lauren Kiel
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Miki Horiguchi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Kelly Meza
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Briana Christophers
- Weill Cornell/Rockefeller/Memorial Sloan Kettering Tri-Institutional MD-PhD Program, New York City, NY, USA
| | | | - Maria Mora Pinzon
- Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sam J Lubner
- Division of Hematology, Medical Oncology and Palliative Care, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Lowe Center for Thoracic Oncology, Harvard Medical School, Dana-Farber Cancer Institute, 450 Brookline Ave - DA1230, 02215, Boston, MA, USA.
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Nguyen M, Meeks LM, Pereira-Lima K, Bullock JL, Addams AN, Moreland CJ, Boatright DB. Medical Student Burnout by Race, Ethnicity, and Multiple Disability Status. JAMA Netw Open 2024; 7:e2351046. [PMID: 38198142 PMCID: PMC10782232 DOI: 10.1001/jamanetworkopen.2023.51046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
This cohort study examines the prevalence of burnout among students underrepresented in medicine by race and ethnicity with multiple disability types.
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Affiliation(s)
- Mytien Nguyen
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Lisa M. Meeks
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Justin L. Bullock
- Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Seattle
| | - Amy N. Addams
- Association of American Medical Colleges, Washington, DC
| | - Christopher J. Moreland
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin
| | - Dowin B. Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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Li H, Upreti T, Do V, Dance E, Lewis M, Jacobson R, Goldberg A. Measuring wellbeing: A scoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. MEDICAL TEACHER 2024; 46:82-101. [PMID: 37405740 DOI: 10.1080/0142159x.2023.2231625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
PURPOSE Studies have demonstrated poor mental health in medical students. However, there is wide variation in study design and metric use, impairing comparability. The authors aimed to examine the metrics and methods used to measure medical student wellbeing across multiple timepoints and identify where guidance is necessary. METHODS Five databases were searched between May and June 2021 for studies using survey-based metrics among medical students at multiple timepoints. Screening and data extraction were done independently by two reviewers. Data regarding the manuscript, methodology, and metrics were analyzed. RESULTS 221 studies were included, with 109 observational and 112 interventional studies. There were limited studies (15.4%) focused on clinical students. Stress management interventions were the most common (40.2%). Few (3.57%) interventional studies followed participants longer than 12 months, and 38.4% had no control group. There were 140 unique metrics measuring 13 constructs. 52.1% of metrics were used only once. CONCLUSIONS Unique guidance is needed to address gaps in study design as well as unique challenges surrounding medical student wellbeing surveys. Metric use is highly variable and future research is necessary to identify metrics specifically validated in medical student samples that reflect the diversity of today's students.
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Affiliation(s)
- Henry Li
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tushar Upreti
- Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
| | - Victor Do
- Department of Pediatrics, Faculty of Medicine, University of Toronto Temerty, Toronto, Canada
| | - Erica Dance
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Melanie Lewis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Ryan Jacobson
- Office of Advocacy and Wellbeing, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Aviva Goldberg
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba Rady, Winnipeg, Canada
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Chen R, Gordon M, Chervenak F, Coverdale J. Addressing Moral Distress After Dobbs v. Jackson Women's Health Organization : A Professional Virtues-Based Approach. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:12-15. [PMID: 37816216 DOI: 10.1097/acm.0000000000005476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
ABSTRACT The June 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization abolished federal protections for reproductive choice. In states where subsequent legislation has restricted or banned access to abortion services, physicians and trainees are prevented from providing ethically justified evidence-based care when patients with previable pregnancies are seeking an abortion. Pregnant patients' vulnerabilities, stress, and the undue burden that they experience when prevented from acting in accordance with their reproductive decision-making can evoke negative emotional consequences, including moral distress in clinicians. Moral distress occurs when clinicians feel a moral compulsion to act a certain way but cannot do so because of external constraints, including being hindered by state laws that curtail practicing in line with professional standards on reproductive health care. Moral distress has the potential to subvert prudent clinical judgment. The authors provide recommendations for managing moral distress in these circumstances based on the professional virtues. The fundamental professional virtues of integrity, compassion, self-effacement, self-sacrifice, and humility inform the management of moral distress and how to respond thoughtfully and compassionately, without over-identification or indifference to the plight of patients denied abortions. The authors also discuss the role of academic leaders and medical educators in cultivating a virtue-based professional culture at the forefront of clinical and educational processes in a post- Dobbs world.
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Tackett S, Steinert Y, Mirabal S, Reed DA, Wright SM. Using Group Concept Mapping to Explore Medical Education's Blind Spots. TEACHING AND LEARNING IN MEDICINE 2023:1-11. [PMID: 37886902 DOI: 10.1080/10401334.2023.2274991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PHENOMENON All individuals and groups have blind spots that can lead to mistakes, perpetuate biases, and limit innovations. The goal of this study was to better understand how blind spots manifest in medical education by seeking them out in the U.S. APPROACH We conducted group concept mapping (GCM), a research method that involves brainstorming ideas, sorting them according to conceptual similarity, generating a point map that represents consensus among sorters, and interpreting the cluster maps to arrive at a final concept map. Participants in this study were stakeholders from the U.S. medical education system (i.e., learners, educators, administrators, regulators, researchers, and commercial resource producers) and those from the broader U.S. health system (i.e., patients, nurses, public health professionals, and health system administrators). All participants brainstormed ideas to the focus prompt: "To educate physicians who can meet the health needs of patients in the U.S. health system, medical education should become less blind to (or pay more attention to) …" Responses to this prompt were reviewed and synthesized by our study team to prepare them for sorting, which was done by a subset of participants from the medical education system. GCM software combined sorting solutions using a multidimensional scaling analysis to produce a point map and performed cluster analyses to generate cluster solution options. Our study team reviewed and interpreted all cluster solutions from five to 25 clusters to decide upon the final concept map. FINDINGS Twenty-seven stakeholders shared 298 blind spots during brainstorming. To decrease redundancy, we reduced these to 208 in preparation for sorting. Ten stakeholders independently sorted the blind spots, and the final concept map included 9 domains and 72 subdomains of blind spots that related to (1) admissions processes; (2) teaching practices; (3) assessment and curricular designs; (4) inequities in education and health; (5) professional growth and identity formation; (6) patient perspectives; (7) teamwork and leadership; (8) health systems care models and financial practices; and (9) government and business policies. INSIGHTS Soliciting perspectives from diverse stakeholders to identify blind spots in medical education uncovered a wide array of issues that deserve more attention. The concept map may also be used to help prioritize resources and direct interventions that can stimulate change and bring medical education into better alignment with the health needs of patients and communities.
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Affiliation(s)
- Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Yvonne Steinert
- Family Medicine and Health Sciences Education, McGill University, Montreal, Québec, Canada
| | - Susan Mirabal
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Darcy A Reed
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Mayo Clinic, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Scott M Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Anderson N, Nguyen M, Marcotte K, Ramos M, Gruppen LD, Boatright D. The Long Shadow: A Historical Perspective on Racism in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S28-S36. [PMID: 37071703 PMCID: PMC10584990 DOI: 10.1097/acm.0000000000005253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
To dismantle racism in U.S. medical education, people must understand how the history of Christian Europe, Enlightenment-era racial science, colonization, slavery, and racism shaped modern American medicine. Beginning with the coalescence of Christian European identity and empire, the authors trace European racial reasoning through the racial science of the Enlightenment into the White supremacist and anti-Black ideology behind Europe's global system of racialized colonization and enslavement. The authors then follow this racist ideology as it becomes an organizing principle of Euro-American medicine and examine how it manifests in medical education in the United States today. Within this historical context, the authors expose the histories of violence underlying contemporary terms such as implicit bias and microaggressions. Through this history, they also gain a deeper appreciation of why racism is so prevalent in medical education and how it affects admissions, assessments, faculty and trainee diversity, retention, racial climate, and the physical environment. The authors then recommend 6 historically informed steps for confronting racism in medical education: (1) incorporate the history of racism into medical education and unmask institutional histories of racism, (2) create centralized reporting mechanisms and implement systematic reviews of bias in educational and clinical activities, (3) adopt mastery-based assessment in medical education, (4) embrace holistic review and expand its possibilities in admissions, (5) increase faculty diversity by using holistic review principles in hiring and promotions, and (6) leverage accreditation to combat bias in medical education. These strategies will help academic medicine begin to acknowledge the harms propagated throughout the history of racism in medicine and start taking meaningful steps to address them. Although the authors have focused on racism in this paper, they recognize there are many forms of bias that impact medical education and intersect with racism, each with its particular history, that deserve their own telling and redress.
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Affiliation(s)
- Nientara Anderson
- N. Anderson is a resident, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mytien Nguyen
- M. Nguyen is an MD-PhD student, Yale School of Medicine, New Haven, Connecticut
| | - Kayla Marcotte
- K. Marcotte is an MD-PhD student, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marco Ramos
- M. Ramos is assistant professor, Section of History of Science and Medicine and Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Larry D Gruppen
- L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Dowin Boatright
- D. Boatright is vice chair of research, Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York
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Torres Acosta MA, Chandra S, Li S, Yoon E, Selgrade D, Quinn J, Ardehali H. The impact of underrepresented minority or marginalized identity status on training outcomes of MD-PhD students. BMC MEDICAL EDUCATION 2023; 23:428. [PMID: 37291579 PMCID: PMC10251672 DOI: 10.1186/s12909-023-04399-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
Dual-degree MD-PhD programs have historically lacked diversity of race, ethnicity, gender, sexual orientation, and other facets of identity. Like MD- and PhD-granting programs, MD-PhD program training environments are also marked by structural barriers that negatively impact measurable academic outcomes of underrepresented and/or marginalized students in academic medicine (racial and ethnic minority groups considered underrepresented by the National Institute of Health, sexual and gender minorities, individuals with disabilities, and individuals of low socioeconomic status). In this article, we review the existing literature on MD-PhD program disparities affecting students from these groups and provide recommendations grounded on the reviewed evidence. Our literature review identified four generalizable barriers that can impact the training outcomes of students from these marginalized and/or underrepresented groups: 1) discrimination and bias, 2) impostor syndrome and stereotype threat, 3) lack of identity-similar mentors, and 4) suboptimal institutional policies and procedures. We propose goal-oriented interventions that may begin to ameliorate the disparities present in MD-PhD program training environments that affect students from marginalized and/or underrepresented groups in academic medicine.
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Affiliation(s)
- Manuel A Torres Acosta
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA.
- Northwestern University's Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Sidhanth Chandra
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Sophia Li
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Department of Biomedical Engineering, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Esther Yoon
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Daniel Selgrade
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jeanne Quinn
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA
- Northwestern University's Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Hossein Ardehali
- Northwestern University's Medical Scientist Training Program, Northwestern University Feinberg School of Medicine, SQBRC 8-521, 303 E Superior Ave, Chicago, IL, 60611, USA.
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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Morrison N, Zaman T, Webster G, Sorinola O, Blackburn C. 'Where are you really from?': a qualitative study of racial microaggressions and the impact on medical students in the UK. BMJ Open 2023; 13:e069009. [PMID: 37147091 PMCID: PMC10163503 DOI: 10.1136/bmjopen-2022-069009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE To explore graduate-entry medical students' experiences of racial microaggressions, the impact of these on learning, performance and attainment, and their views on how these can be reduced. DESIGN Qualitative study using semistructured focus groups and group interviews. SETTING UK. PARTICIPANTS 20 graduate-entry medical students were recruited using volunteer and snowball sampling; all students self-identified as being from racially minoritised (RM) backgrounds. RESULTS Participants reported experiencing numerous types of racial microaggressions during their time at medical school. Students' accounts highlighted how these impacted directly and indirectly on their learning, performance and well-being. Students frequently reported feeling uncomfortable and out of place in teaching sessions and clinical placements. Students also reported feeling invisible and ignored in placements and not being offered the same learning opportunities as their white counterparts. This led to lack of access to learning experiences or disengagement from learning. Many participants described how being from an RM background was associated with feelings of apprehension and having their 'guards up', particularly at the start of new clinical placements. This was perceived to be an additional burden that was not experienced by their white counterparts. Students suggested that future interventions should focus on institutional changes to diversify student and staff populations; shifting the culture to build and maintain inclusive environments; encouraging open, transparent conversations around racism and promptly managing any student-reported racial experiences. CONCLUSION RM students in this study reported that their medical school experiences were regularly affected by racial microaggressions. Students believed these microaggressions impeded their learning, performance and well-being. It is imperative that institutions increase their awareness of the difficulties faced by RM students and provide appropriate support in challenging times. Fostering inclusion as well as embedding antiracist pedagogy into medical curricula is likely to be beneficial.
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Affiliation(s)
- Nariell Morrison
- Department of Education, University of Oxford, Oxford, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tabbasum Zaman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Georgia Webster
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olanrewaju Sorinola
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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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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Rachoin JS, Vilceanu MO, Franzblau N, Gordon S, Hunter K, Cerceo E. Influence of demographic and socio-economic factors in choosing hospitalist careers among US medical students. BMC MEDICAL EDUCATION 2022; 22:736. [PMID: 36284333 PMCID: PMC9597950 DOI: 10.1186/s12909-022-03792-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students. METHODS We analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020. RESULTS We analyzed 46,614 questionnaires. 19.3% of respondents (N = 8,977) intended to work as a Hospital Medicine [HM] (unchanged from 2018 to 2020), mostly combined with specialties in Internal medicine (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, sexual orientation minorities (Lesbian/Gay or Bisexual), Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher median total debt ($170,000 vs. $155,000). Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM. CONCLUSION About one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of debt, planning to enter a loan forgiveness program, or are interested in doing a fellowship.
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Affiliation(s)
- Jean-Sebastien Rachoin
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ United States of America
| | - M. Olguta Vilceanu
- Department of Public Relations and Advertising, Rowan University, Glassboro, NJ United States of America
| | - Natali Franzblau
- Department of Obstetrics and Gynecology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ United States of America
| | - Sabrina Gordon
- Department of Medicine, Cooper University Healthcare, New Jersey, Camden, United States of America
| | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ United States of America
| | - Elizabeth Cerceo
- Division of Hospital Medicine, Department of Medicine, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ United States of America
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Nguyen M, Chaudhry SI, Asabor E, Desai MM, Lett E, Cavazos JE, Mason HRC, Boatright D. Variation in Research Experiences and Publications During Medical School by Sex and Race and Ethnicity. JAMA Netw Open 2022; 5:e2238520. [PMID: 36282497 PMCID: PMC9597391 DOI: 10.1001/jamanetworkopen.2022.38520] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Diverse research teams are critical to solving complex health problems and producing high-quality medical research. OBJECTIVE To examine the associations of student sex and racial and ethnic identity with publication rates during medical school. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed individual-level data of US MD graduates from medical school who matriculated in academic years 2014 to 2015 and 2015 to 2016. Data were obtained from the Association of American Medical Colleges and analyzed from October 2021 to January 2022. MAIN OUTCOMES AND MEASURES Outcomes of interest included students' self-reported participation in unique research experiences, number of publications, and computed publications per research experience. Poisson regressions were constructed to determine the association of sex and racial and ethnic identity with research outcomes using adjusted rate ratios (aRRs). RESULTS Among 31 474 graduates, 15 159 (48.2%) identified as women and 4344 (13.8%) identified as underrepresented in medicine by race and ethnicity (URIM; including American Indian, Alaska Native, Black, Hawaiian Native, Hispanic/Latinx, and Pacific Islander individuals). Students who attended National Institutes of Health (NIH) top 40 research-ranked schools reported higher number of research experiences and publication counts, resulting in a higher publication rate compared with students from non-top 40 schools (median [IQR] 1.60 [1.00-3.00] vs 1.25 [0.50-2.33]; P < .001). Women reported a higher number of research experiences than men but a significantly lower number of publications (top 40 schools: aRR, 0.89; 95% CI, 0.87-0.90; non-top 40 schools: aRR, 0.93; 95% CI, 0.92-0.95). This resulted in a significantly lower publication rate among women (top 40 schools: aRR, 0.85; 95% CI, 0.83-0.86; non-top 40 schools: aRR, 0.91; 95% CI, 0.90-0.92). Compared with White students, Asian students had higher publication rates at both NIH top 40 schools (aRR, 1.10; 95% CI, 1.08-1.12) and non-top 40 schools (aRR, 1.07; 95% CI, 1.05-1.08), while lower publication rates were reported among Black students (top 40 schools: aRR, 0.83; 95% CI, 0.80-0.86; non-top 40 schools: aRR, 0.88; 95% CI, 0.85-0.95) and Hispanic students attending non-top 40 schools (aRR, 0.93; 95% CI, 0.90-0.95). CONCLUSIONS AND RELEVANCE These findings illustrate that inequities in the physician-scientist workforce began early in training and highlight key areas for intervention, such as funding support and mentorship training during undergraduate medical education, that may promote the future success of a diverse physician-scientist workforce.
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Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Sarwat I. Chaudhry
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Elle Lett
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jose E. Cavazos
- South Texas Medical Scientist Training Program, University of Texas Health San Antonio, San Antonio
| | | | - Dowin Boatright
- Department of Emergency Medicine, New York Grossman School of Medicine, New York
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Nguyen M, Desai MM, Boatright D. Clarifying Associations of Individual Factors With Medical School Attrition-Reply. JAMA Pediatr 2022; 176:2796977. [PMID: 36190711 DOI: 10.1001/jamapediatrics.2022.3523] [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)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology and Office of Diversity, Equity, Inclusion, and Belonging, Yale School of Public Health, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York
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Westafer LM, Freiermuth CE, Lall MD, Muder SJ, Ragone EL, Jarman AF. Experiences of Transgender and Gender Expansive Physicians. JAMA Netw Open 2022; 5:e2219791. [PMID: 35767255 PMCID: PMC9244607 DOI: 10.1001/jamanetworkopen.2022.19791] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Although LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority) physicians experience bias in the workplace, there is a paucity of data on the experiences of physicians who identify specifically as transgender and/or gender expansive (TGE; gender expansive is an umbrella term encompassing individuals and gender identities that may exist beyond the binary framework [eg, may include nonbinary, genderqueer, and agender individuals]). Objectives To explore the professional experiences of TGE physicians, identify barriers to inclusion, and highlight stakeholder-derived strategies that promote an inclusive workplace. Design, Setting, and Participants This qualitative study informed by semistructured interviews was conducted among 24 TGE physicians in the US from April 1 to December 31, 2021. The sample of TGE physicians was recruited using convenience and snowball sampling. Interviews were recorded and transcribed. Using thematic analysis, at least 2 members of the research team performed blinded coding of each transcript, in an iterative process. Main Outcomes and Measures Data collection and thematic analysis examining themes of physicians' experiences. Results Among 24 physicians (mean [SD] age, 39 [1.4] years) interviewed, 8 (33%) self-identified as transgender women, 7 (29%) as transgender men, 4 (17%) as nonbinary, 3 (13%) as transgender and nonbinary, and 2 (8%) as genderqueer. Prominent themes of the interviews included emotional distress as a result of transphobia, dominance of a rigid binary gender paradigm, and structural and institutional factors that are associated with psychological and physical safety and feelings of isolation as a TGE physician. Clear steps of affirmation were identified that could mitigate the emotional stressors, including signs of safety, active allyship, and mentorship by other TGE physicians. Conclusions and Relevance In this qualitative study, TGE physicians reported facing both overt and subtle biases associated with their identity and gender presentation. Participants also noted several interpersonal and structural factors that mitigate the effect of these biases.
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Affiliation(s)
- Lauren M. Westafer
- Department for Healthcare Delivery and Population Science, University of Massachusetts Chan Medical School–Baystate, Springfield
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michelle D. Lall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah J. Muder
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Eleanor L. Ragone
- Department of Emergency Medicine, University of Massachusetts Chan Medical School–Baystate, Springfield
| | - Angela F. Jarman
- Department of Emergency Medicine, University of California, Davis, Sacramento
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Ryus CR, Samuels EA, Wong AH, Hill KA, Huot S, Boatright D. Burnout and Perception of Medical School Learning Environments Among Gay, Lesbian, and Bisexual Medical Students. JAMA Netw Open 2022; 5:e229596. [PMID: 35486396 PMCID: PMC9055452 DOI: 10.1001/jamanetworkopen.2022.9596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. OBJECTIVE To understand SM medical students' perceptions of the medical school learning environment and how this is associated with reported burnout. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)-accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. EXPOSURES Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. MAIN OUTCOMES AND MEASURES Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5-point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. RESULTS A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. CONCLUSIONS AND RELEVANCE In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.
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Affiliation(s)
- Caitlin R. Ryus
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Stephen Huot
- Office of Graduate Medical Education, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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