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Lane J, Alizadeh N, Daclan A, Vickery A. Exploring the Impact of Equity, Diversity, and Inclusion Initiatives Within a Canadian Nursing Program: A Pilot Study. Creat Nurs 2024:10784535241267944. [PMID: 39166280 DOI: 10.1177/10784535241267944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Interventions that aim to address equity, diversity, and inclusion (EDI) within the health professions often strive to promote the retention, recruitment, and success of individuals from historically underrepresented groups, who often belong to the same groups experiencing underservicing in health care. A pilot study aimed to examine the impact of ongoing EDI initiatives at Dalhousie University in Nova Scotia, Canada by exploring sense of belonging and curricular inclusion/representation from the perspectives of enrolled students. Intersectionality Theory was operationalized by way of considering the relational and contextual nature of marginalization. Results showed differences in perceptions of impacted sense of belonging and curricular inclusion/representation of diverse groups between respondents in the underrepresented subgroup as compared to their overrepresented counterparts. Differences in underrepresented and overrepresented subgroups' perceptions of impacted sense of belonging and curricular inclusion/representation suggest a need for further research to better understand the impact of EDI interventions on nursing students.
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Affiliation(s)
- Jennifer Lane
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Neda Alizadeh
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Anika Daclan
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Adam Vickery
- School of Nursing, Dalhousie University, Halifax, NS, Canada
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Kechi IA, Waite R, Murray TA. Examining and mitigating racism in nursing using the socio-ecological model. Nurs Inq 2024; 31:e12639. [PMID: 38567694 DOI: 10.1111/nin.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 07/31/2024]
Abstract
Racism in nursing is multifaceted, ranging from internalized racism and interpersonal racism to institutional and systemic (or structural) elements that perpetuate inequities in the nursing profession. Employing the socio-ecological model, this study dissects the underlying challenges across various levels and proposes targeted mitigation strategies to foster an inclusive and equitable environment for nursing education. It advances clear, context-specific mitigation strategies to cultivate inclusivity and equity within nursing education. Effectively addressing racism within this context necessitates a tailored, multistakeholder approach, impacting nursing students, faculty, administration, professional organizations, and licensing and accrediting bodies. This all-encompassing strategy recognizes that the interplay of interpersonal dynamics, community culture, institutional policies, and broader societal structures intricately shapes individual experiences. Nurses, nurse leaders, educators, organizations, and policymakers can work together to create a more equitable and inclusive nursing profession by targeting each of these levels. This transformational process can yield positive outcomes across various environments where nurses learn, work, and serve people and enable the demographic composition of nurses to better match the populations served.
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Affiliation(s)
- Iheduru-Anderson Kechi
- School of Rehabilitation and Medical Sciences, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, MI, USA
| | - Roberta Waite
- Georgetown University School of Nursing, Washington, DC, USA
| | - Teri A Murray
- Trudy Busch Valentine School of Nursing, Saint Louis University, Saint Louis, MI, USA
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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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Morreale MK, Rakofsky J, Beck Dallaghan GL, Russo RA, Thomas LA, Balon R. Exploring Career Choice Among Black Psychiatry Interns: an Exploratory Qualitative Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:153-157. [PMID: 37493959 DOI: 10.1007/s40596-023-01826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Relative to the Black American population size, there is an underrepresentation of Black psychiatrists in the USA. In order to address this issue, it is important to explore factors that contribute to Black medical students' decision to pursue a career in psychiatry. METHODS First-year psychiatry residents who identify as Black (N = 7) were interviewed. Career Construction Theory provided a structured framework for the interview process. For qualitative analysis of data, codes were assigned to reflect concepts and develop themes. RESULTS All participants mentioned the impact of being a Black psychiatrist in the Black community, the influence of strong female role models on their life, and the importance of the fit between their personality and the work done within psychiatry. The majority of interviewees identified macro-level and cultural events that had influenced them and discussed a desire for advocacy and the influence of Black role models, perseverance, and the importance of work-life balance. CONCLUSION This qualitative study identified many influential factors that were deemed important to Black interns in their decision to pursue a residency in psychiatry. With the information learned from these interviews, educators within psychiatry can bolster their support of Black medical students, encourage pursuit of a career in psychiatry, and ultimately, work toward reducing disparities in psychiatric care. Future research should examine additional collective notions of career decision-making.
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Affiliation(s)
| | | | | | - Rachel A Russo
- Veterans Affairs Medical Center San Diego/University of California San Diego, San Diego, CA, USA
| | - Lia A Thomas
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, TX, Dallas, USA
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Mulder L, Wouters A, Akwiwu EU, Koster AS, Ravesloot JH, Peerdeman SM, Salih M, Croiset G, Kusurkar RA. Diversity in the pathway from medical student to specialist in the Netherlands: a retrospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100749. [PMID: 37860636 PMCID: PMC10583163 DOI: 10.1016/j.lanepe.2023.100749] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
Background Medical specialist workforces are not representative of the society they serve, partially due to loss of diversity in the path from student to specialist. We investigated which demographic characteristics of bachelor students of medicine (BSM) are associated with becoming a physician and (particular type of) medical specialist; and whether this suggests 'cloning' (reproduction of sameness) of the existing workforce. Methods We used a retrospective cohort design, based on Statistics Netherlands data of all first-year BSM in 2002-2004 in The Netherlands (N = 4503). We used logistic regression to analyze the impact of sex, migration background, urbanity of residence, parental income and assets categories, and having healthcare professional parents, on being registered as physician or medical specialist in 2021. We compared our results to the national pool of physicians (N = 76,845) and medical specialists (N = 49,956) to identify cloning patterns based on Essed's cultural cloning theory. Findings Female students had higher odds of becoming a physician (OR 1.87 [1.53-2.28], p < 0.001). Physicians with a migration background other than Turkish, Moroccan, Surinamese, Dutch Caribbean or Indonesian (TMSDI) had lower odds of becoming a specialist (OR 0.55 [0.43-0.71], p < 0.001). This was not significant for TMSDI physicians (OR 0.74 [0.54-1.03], p = 0.073). We found a cloning pattern with regard to sex and migration background. Nationwide, physicians with a Turkish or Moroccan migration background, and female physicians with other migration backgrounds, are least likely to be a medical specialist. Interpretation In light of equity in healthcare systems, we recommend that every recruitment body increases the representativeness of their particular specialist workforce. Funding ODISSEI.
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Affiliation(s)
- Lianne Mulder
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
| | - Anouk Wouters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
| | - Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Andries S. Koster
- Department of Pharmaceutical Sciences, Utrecht University, David de Wied Building, Universiteitsweg 99, Utrecht, the Netherlands
| | - Jan Hindrik Ravesloot
- Amsterdam UMC Location University of Amsterdam, Faculty of Medicine, Department of Medical Biology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Saskia M. Peerdeman
- Amsterdam UMC Location University of Amsterdam, Department Neurosurgery, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Faculty of Medicine, Teaching and Learning Centre, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Mahdi Salih
- Erasmus MC, Division of Nephrology and Transplantation, Department of Internal Medicine, Dr. Molewaterplein 40, Rotterdam, The Netherlands
| | - Gerda Croiset
- University Medical Center Groningen, Wenckebach Institute for Education and Training, Hanzeplein 1, Groningen, the Netherlands
| | - Rashmi A. Kusurkar
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, De Boelelaan 1118, Amsterdam, the Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Lechien JR, Kan K, Sims HS. Workplace Environment Microaggressions in Otolaryngology-Head and Neck Surgery: An International Survey. Otolaryngol Head Neck Surg 2023; 169:1481-1490. [PMID: 37300899 DOI: 10.1002/ohn.400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/30/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To survey members of the otolaryngology community about their personal and observed experiences of being treated differently because of one's physical attributes, cultural norms, or preferences in the workplace. STUDY DESIGN Cross-sectional survey. SETTING International Electronic Survey. METHODS We invited members of the international otolaryngology community including 3 European or American otorhinolaryngological Societies to complete a survey about personal/observed experience of differential treatment in the workplace related to age, biological sex; disability, gender identity, language proficiency, military experience, citizenship, ethnicity/race, political belief, and sexual orientation. Results were analyzed according to participant ethnicity/race (white vs non-white) and gender (male vs female) RESULTS: Four hundred seven participants completed the evaluations: 301 white (74%) and 106 non-white (26%) participants. Non-white participants reported significantly more experiences of differential treatment (microaggressions) than white participants (p < .05). Non-white participants more frequently felt that they needed to work harder for the same opportunities as their peers and were more likely to consider leaving a position because of an unsupportive environment. In general, females reported more frequent experiences with differential treatment related to sexual orientation, biological sex, and gender identity than males. CONCLUSION We recognized reports of differential treatment as a proxy for microaggressions. Non-white members of the otolaryngology community self-report experiencing or observing more microaggressions than white members in the workplace. Acknowledging the existence and impact of microaggressions in the field of Otolaryngology is the first step towards cultivating an inclusive, diverse workforce where all members feel supported, validated, and welcomed.
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Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology and Head and Neck Surgery, Division of Laryngology and Broncho-Esophagology, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otolaryngology Head Neck Surgery, CHU Saint-Pierre, Brussels, Belgium
- Otolaryngology Head Neck Surgery, Elsan Polyclinic of Poitiers, Poitiers, France
| | - Krystal Kan
- Department of Otolaryngology-Head & Neck Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - H Steven Sims
- Department of Otolaryngology-Head & Neck Surgery, Chicago Institute for Voice Care, University of Illinois at Chicago, Chicago, Illinois, USA
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Perry R, Sciolla A, Rea M, Sandholdt C, Jandrey K, Rice E, Yu A, Griffin E, Wilkes M. Modeling the social determinants of resilience in health professions students: impact on psychological adjustment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1661-1677. [PMID: 37193860 PMCID: PMC10187518 DOI: 10.1007/s10459-023-10222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/05/2023] [Indexed: 05/18/2023]
Abstract
Stressors inherent to training and stemming from the learning environment are associated with high rates of burnout, depression, and mental health problems in health professions students (HPS). There is evidence that disadvantaged or stigmatized groups are particularly affected. These problems not only impact students after graduation but may also have detrimental effects on patient outcomes. Resilience, conceptualized as the process of adapting well in the face of adversity, has inspired an increasing number of interventions aimed at addressing those problems in HPS. These interventions have mostly targeted individual students and their psychological traits while ignoring social and structural factors that may enhance or undermine individual resilience. To address this gap in the literature, the authors reviewed the evidence for psychosocial determinants of resilience and proposed a model inspired by the social determinants of health literature and the "upstream-downstream" metaphor. In this theoretical paper, the authors propose that upstream determinants such adverse childhood experiences and socioeconomic and sociodemographic markers of disadvantage have a direct effect on psychological adjustment and an indirect effect mediated by resilience. Additionally, the authors propose that the institutional downstream drivers of learning environment, social support, and sense of belonging moderate the direct and indirect effects of the upstream determinants on psychological adjustment. Future research should test these hypotheses and gather evidence that may guide the development of interventions. The authors present their model as part of a comprehensive response to recent calls to action to address diversity, equity and inclusion in health professions education.
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Affiliation(s)
- Ross Perry
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Andres Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | - Margaret Rea
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Cara Sandholdt
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Karl Jandrey
- School of Veterinary Medicine, University of California, Davis , Davis, CA, USA
| | - Elizabeth Rice
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA
| | - Allison Yu
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Erin Griffin
- Washington State University, Elson S. Floyd College of Medicine, Spokane, WA, USA
| | - Michael Wilkes
- School of Medicine, University of California, Davis, Sacramento, CA, USA.
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Delgado AC, Dowling S, Sanchez-Guzman M, Sebok-Syer SS, Gisondi MA. Belongingness among first-generation students at Stanford School of Medicine. MEDEDPUBLISH 2023; 13:288. [PMID: 38694949 PMCID: PMC11061589 DOI: 10.12688/mep.19912.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 05/04/2024] Open
Abstract
Background Nationally, underrepresented minorities represent a significant proportion of the first-generation student population. These students also tend to report lower levels of belongingness compared to their peers, which may impact their wellness and be an important factor in their academic success. This study aimed to explore whether status as a first-generation student was associated with belongingness amongst medical students. Methods In 2019, a previously validated 16-item survey was used to examine potential disparities in belongingness amongst groups of first-generation medical students. Differences between groups were assessed using a Mann-Whitney U-test for each individual item and three composite groupings of items regarding social belonging, academic belonging, and institutional support. Results First-generation to college and first-generation to graduate school students reported lower belongingness across most individual items as well as in all three composite groups. Conclusions Given that peer relationships and institutional support play an important role in medical student belonging, these findings represent an opportunity to address the specific needs of individuals from underrepresented groups in medicine. Doing so can support the academic and professional success of first-generation students and help close the diversity gap in medicine.
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Affiliation(s)
| | - Sean Dowling
- Emergency Medicine, Stanford Health Care, Palo Alto, California, USA
| | | | - Stefanie S. Sebok-Syer
- Emergency Medicine, Stanford Health Care, Palo Alto, California, USA
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Michael A. Gisondi
- Emergency Medicine, Stanford Health Care, Palo Alto, California, USA
- School of Medicine, Stanford University, Palo Alto, California, USA
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Kindratt TB, Brannon GE, Boateng GO, Brown KK. The Influence of Racial/Ethnic and Gender Concordance on Care Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus: an Analysis of the Medical Expenditure Panel Survey, 2010-2019. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01779-z. [PMID: 37707662 DOI: 10.1007/s40615-023-01779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION This study examined associations between patient-provider race/ethnicity concordance and gender concordance on overall healthcare ratings, self-efficacy, and diabetes care monitoring in non-pregnant women of childbearing age with diabetes mellitus before and after adjusting for sociodemographic factors. METHODS We analyzed longitudinal data from the 2010-2019 Medical Expenditure Panel Survey. The sample was limited to non-pregnant women of childbearing age (18-45 years) diagnosed with diabetes (unweighted n = 327; weighted n = 566,504). Bivariate analysis, logistic regression, and latent variable modeling were performed. RESULTS Few racially minoritized women reported racial/ethnic and gender concordance with their healthcare provider. Only 2.9% of Hispanic women reported having a Hispanic provider and 12.1% of non-Hispanic Black women reported seeing a non-Hispanic Black provider compared to 81.1% of non-Hispanic White women who reported seeing a non-Hispanic White provider (p < .0001). Among Hispanic women, 15.3% reported seeing a female provider compared to 25.2% of non-Hispanic Black and 53.5% of non-Hispanic White women. Patient-provider race/ethnicity and gender concordance were not statistically significantly associated with overall healthcare ratings, self-efficacy, or diabetes care monitoring. CONCLUSIONS This study revealed a large disparity in race/ethnicity and gender concordance among minority women of reproductive age with diabetes compared to their non-Hispanic White counterparts. There is a need for larger, more robust studies to examine the influence of provider and other healthcare characteristics on diabetes-related outcomes in this understudied population.
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Affiliation(s)
- Tiffany B Kindratt
- Department of Kinesiology, The University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA.
| | - Grace Ellen Brannon
- Department of Communication, The University of Texas at Arlington, 700 W. Greek Row Drive, Arlington, TX, 76019, USA
| | - Godfred O Boateng
- Department of Kinesiology, The University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
- School of Global Health, York University, 4700 Keele St, Toronto, M3J 1P3, Canada
| | - Kyrah K Brown
- Department of Kinesiology, The University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, 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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Nadarajah VD, Ramani S, Findyartini A, Sathivelu S, Nadkar AA. Inclusion in global health professions education communities through many lenses. MEDICAL TEACHER 2023:1-3. [PMID: 36943436 DOI: 10.1080/0142159x.2023.2186206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In this paper, we reflect on what inclusion can mean to the global Health Professions Education (HPE) community, the impact of lack of inclusion, and offer suggestions on how to be inclusive. To illustrate the impact of inclusion, we offer perspectives from the lens of a medical student, junior doctor, educators, and educational leaders. The viewpoints offered in this communication can be useful to broaden and nurture inclusive pedagogy and scholarship. Furthermore, since the aim of HPE is high quality patient care and social advocacy, emphasising inclusion in HPE could enhance inclusion in patient care.
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Affiliation(s)
- Vishna Devi Nadarajah
- School of Medicine and IMU Centre of Education (ICE), International Medical University, Kuala Lumpur, Malaysia
| | - Subha Ramani
- Harvard Medical School, Massachusetts General Hospital Institute for Health Professions Education, Boston, MA, USA
| | - Ardi Findyartini
- Medical Education Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Savithri Sathivelu
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Azhar Adam Nadkar
- Faculty of Medicine and Health Sciences (FMHS), Tygerberg Academic Hospital, Stellenbosch University, Stellenbosch, South Africa
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Verbree AR, Isik U, Janssen J, Dilaver G. Inclusion and diversity within medical education: a focus group study of students' experiences. BMC MEDICAL EDUCATION 2023; 23:61. [PMID: 36698110 PMCID: PMC9875758 DOI: 10.1186/s12909-023-04036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND/INTRODUCTION As patient populations become more diverse, it is imperative that future physicians receive proper training in order to provide the best quality of care. This study examines medical students' perceptions of how prepared they are in dealing with a diverse population and assesses how included and supported the students felt during their studies. METHODS Four semi-structured focus groups were held with medical students across all years of the medical study program of a Dutch university. Focus group transcripts were analyzed thematically. RESULTS Students' experiences could be categorized as follows: (1) (Minority) identities and personal motivations, (2) Understanding of diversity and an inclusive learning environment, (3) Diversity in education, (4) Experiences of exclusion, (5) Experiences of inclusion, and (6) Lack of awareness. The key findings from the focus groups were that students perceived a lack of diversity and awareness in medical education and were convinced of the need to incorporate diversity to a greater extent and were personally motivated to contribute to incorporating diversity in the curriculum. Students also shared exclusion experiences such as stereotypes and prejudices but also some inclusion experiences such as feelings of belonging. CONCLUSION Based on our findings, it is recommended that medical schools incorporate diversity education into their curriculum so that health professionals can provide the best quality of care for their diverse patient populations. This education should also ensure that all students feel included in their medical education program.
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Affiliation(s)
- Anne-Roos Verbree
- Education Center, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Ulviye Isik
- Education Center, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Jeroen Janssen
- Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands
| | - Gönül Dilaver
- Education Center, University Medical Center Utrecht, Utrecht, Netherlands
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Mukherji P, Adas MA, Clarke B, Galloway JB, Mulvey T, Norton S, Turner J, Russell MD, Lempp H, Li S. Changing trends in ethnicity and academic performance: observational cohort data from a UK medical school. BMJ Open 2022; 12:e066886. [PMID: 36521901 PMCID: PMC9756189 DOI: 10.1136/bmjopen-2022-066886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Quantify differential attainment by ethnicity in undergraduate medical assessments and evaluate whether institutional efforts to reduce the attainment gap have had impact. DESIGN Observational cohort study. SETTING A single UK MBBS medical programme. PARTICIPANTS Pseudonymised data of adults aged ≥18 years enrolled in one of the UK MBBS medical programmes between 2012 and 2018. Ethnicity was self-declared during enrolment as White, Asian, Black, mixed and other. MAIN OUTCOME MEASURE Module mark (distinction, merit, pass, fail) graded according to a variety of assessments, including single best answer examinations, objective structured clinical examinations and coursework submissions. All modular assessments are graded as a percentage. Logistic regression models were used to calculate relative risk ratio to study the association between ethnicity and attainment gap over a calendar and scholastic year. Models were adjusted for age, gender, social deprivation and scholastic year of study. RESULTS 3714 student records were included. In the sample, 2134 students (57%) were non-white. The proportion of non-white students increased from 2007 (49%) to 2018 (70%). Mean age was 18 (IQR 18-21) and 56.6% were females. Higher proportion of non-white students 218 (24.8%) were from more deprived backgrounds versus white 76 (14.8%). Compared with non-white, there were no significant differences in the proportion of students failing assessments. However, white students were more likely to achieve merit (relative risk ratio 1.29 (95% CI 1.08 to 1.45)) or distinction (1.69 (95% CI 1.37 to 2.08)). Differences in attainment gap have remained unchanged over time, and for black students, attainment gap grew between their first and final year of study. CONCLUSION A similar proportion (97%) of non-white and white students had a passing score, but attainment gap for higher grades persists over years despite widespread efforts in medical schools to diminish the attainment gap linked to ethnicity. Our findings are from a single institution, thus affecting generalisability.
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Affiliation(s)
| | - Maryam A Adas
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Benjamin Clarke
- Postgraduate Medical & Dental Education Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - James B Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Thomas Mulvey
- Clinical Education Department, King's College London, London, UK
| | - Sam Norton
- Psychology Department, Insitute of Psychiatry, King's College London, London, UK
| | - Jonathan Turner
- Clinical Education Department, King's College London, London, UK
| | - Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Shuangyu Li
- Division of Medical Education, King's College London, London, UK
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Berreta K. Comments on "Mini-medical school programs decrease perceived barriers of pursuing medical careers among underrepresented minority high school students". J Osteopath Med 2022; 122:603-604. [PMID: 35795963 DOI: 10.1515/jom-2022-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Krisdaniel Berreta
- Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, SC, USA
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Díaz Rios LK, Stage VC, Leak TM, Taylor CA, Reicks M. Collecting, Using, and Reporting Race and Ethnicity Information: Implications for Research in Nutrition Education, Practice, and Policy to Promote Health Equity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:582-593. [PMID: 35351358 DOI: 10.1016/j.jneb.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
This report will describe approaches for collecting, analyzing, and reporting race and ethnicity information in nutrition education and behavior research, practice, and policy to advance health equity. Race and ethnicity information is used to describe study participants and compare nutrition and health-related outcomes. Depending on the study design, race and ethnicity categories are often defined by the research question or other standardized approaches. Participant self-reported data are more acceptable than researcher adjudicated identification data, which can add bias and/or error. Valid methods to collect, use, and report race and ethnicity information are foundational to publication quality, findings of value, contribution to the knowledge base, and health equity.
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Affiliation(s)
- L Karina Díaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA
| | - Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Tashara M Leak
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St Paul, MN.
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van Andel CEE, Born MP, van den Broek WW, Stegers‐Jager KM. Student ethnicity predicts social learning experiences, self-regulatory focus and grades. MEDICAL EDUCATION 2022; 56:211-219. [PMID: 34543459 PMCID: PMC9293402 DOI: 10.1111/medu.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 06/03/2023]
Abstract
CONTEXT Ethnic minority students find that their ethnicity negatively affects the evaluation of their capacities and their feelings in medical school. This study tests whether ethnic minority and majority students differ in their 'self-regulatory focus' in clinical training, that is, their ways to approach goals, due to differences in social learning experiences. Self-regulatory focus consists of a promotion and prevention focus. People who are prone to stereotypes and unfair treatments are more likely to have a prevention focus and conceal certain identity aspects. The objectives of the study are to test whether ethnic minority students, as compared with ethnic majority students, are equally likely to have a promotion focus, but more likely to have a prevention focus in clinical training due to more negative social learning experiences (Hypothesis 1), and whether the relationship between student ethnicity and clinical evaluations can be explained by students' gender, social learning experiences, self-regulatory focus and impression management (Hypothesis 2). METHODS Survey and clinical evaluation data of 312 (71.2% female) clerks were collected and grouped into 215 ethnic majority (69.4%) and 95 ethnic minority students (30.6%). Students' social learning experiences were measured as perceptions of unfair treatment, trust in supervisors and social academic fit. Self-regulatory focus (general and work specific) and impression management were also measured. A parallel mediation model (Hypothesis 1) and hierarchical multiple regression analyses were used (Hypothesis 2). RESULTS Ethnic minority students had higher perceptions of unfair treatment and lower trust in their supervisors in clinical training. They were more prevention focused in clinical training, but this was not mediated by having more negative social learning experiences. Lower clinical evaluations for ethnic minority students were unexplained. Promotion focus in clinical training and trust in supervisors positively relate to clinical grades. CONCLUSION Student ethnicity predicts social learning experiences, self-regulatory focus and grades in clinical training. The hidden curriculum plausibly plays a role here.
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Affiliation(s)
| | - Marise P. Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
- Optentia and Faculty of Economic and Management SciencesNorth‐West UniversityPotchefstroomSouth Africa
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Joseph OR, Flint SW, Raymond-Williams R, Awadzi R, Johnson J. Understanding Healthcare Students' Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312771. [PMID: 34886495 PMCID: PMC8657581 DOI: 10.3390/ijerph182312771] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/30/2022]
Abstract
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.
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Affiliation(s)
- Olivia Rochelle Joseph
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- Correspondence:
| | - Stuart W. Flint
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Scaled Insights, Nexus, University of Leeds, Leeds LS2 3AA, UK
| | | | - Rossby Awadzi
- Postgraduate Graduate Medical Education, Northwick Park Hospital, London HA1 3UJ, UK;
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds LS2 9JU, UK; (S.W.F.); (J.J.)
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford BD9 6RJ, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney 2052, Australia
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