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Ramzy LM, Monson SP, Chao HWI, Hileman B, Podewils LJ, Pereira RI. Power Dynamics Perpetuate DEI Inaction: A Qualitative Study of Community Health Clinic Teams. Ann Fam Med 2024; 22:203-207. [PMID: 38806273 PMCID: PMC11237218 DOI: 10.1370/afm.3099] [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] [Received: 06/25/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams. METHODS We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified. RESULTS Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift. CONCLUSIONS Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care.
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Affiliation(s)
- Laura Marie Ramzy
- Integrated Behavioral Health, Ambulatory Care Services, Denver Health and Hospital Authority, Denver, Colorado
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Samantha Pelican Monson
- Integrated Behavioral Health, Ambulatory Care Services, Denver Health and Hospital Authority, Denver, Colorado
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Bethany Hileman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Laura Jean Podewils
- Office of Research, Denver Health and Hospital Authority, Denver, Colorado
- Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Rocio I Pereira
- Office of Health Equity, Denver Health and Hospital Authority, Denver, Colorado
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado
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Kiles TM, Nonyel NP, Higgins M, Campbell HE. White coats, Black lives-racial trauma in Black pharmacists. J Am Pharm Assoc (2003) 2024; 64:450-456. [PMID: 38143040 DOI: 10.1016/j.japh.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Race-based traumatic stress, or racial trauma, can negatively impact the health and wellbeing of Black health professionals. However, the effects of racial trauma among Black pharmacists have not been thoroughly explored. OBJECTIVE The purpose of this study is to explore Black pharmacist experiences of race-based traumatic stress and its effects in the workplace. METHODS This qualitative study utilized focus groups among a convenience sample of Black pharmacist attendees of a national convention for an organization dedicated to serving underserved communities and minoritized pharmacy professionals. The data were analyzed with inductive coding and thematic analysis as proposed by Braun and Clark. RESULTS Three focus groups were conducted with a total of 22 participants. The majority of participants were female (77%), and the average age of the participants was 48.3 years old. Three themes related to racial trauma were identified. The participants described racial trauma as an ever-present phenomenon, tension with coworkers and institutions, and internal and external structures of support. The Black pharmacists in this study provided context and recommendations for employers to support their wellbeing. CONCLUSIONS An awareness of the hidden wounds that Black pharmacists carry with them to work every day is an important factor in creating diverse and inclusive workplaces. The results of this study give Black pharmacists a voice and a chance to share with colleagues their distinct realities. Employers and institutions should assess individual needs and implement strategies to support Black pharmacists in creating more inclusive work and professional environments.
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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [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] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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Tong M, Hurtado A, Deshpande R, Pietrzak RH, He C, Kaplan C, Kaplan S, Akhtar S, Feder A, Feingold JH, Ripp JA, Peccoralo LA. Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic. J Gen Intern Med 2024; 39:450-459. [PMID: 37845586 PMCID: PMC10897117 DOI: 10.1007/s11606-023-08422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). OBJECTIVE To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. DESIGN A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. PARTICIPANTS Frontline HCWs at an urban tertiary care hospital in New York City. MAIN MEASURES Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. KEY RESULTS Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). CONCLUSIONS Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.
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Affiliation(s)
- Michelle Tong
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Alicia Hurtado
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Richa Deshpande
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Carly Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Sabrina Kaplan
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
| | - Saadia Akhtar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordyn H Feingold
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan A Ripp
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Peccoralo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA.
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Johnson VE, Chng K, Courtney K. Racial trauma as a risk factor for risky alcohol use in diverse college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37289971 DOI: 10.1080/07448481.2023.2214247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023]
Abstract
Exposure to potentially traumatic race-based experiences poses a risk factor for risky drinking among college students from historically marginalized racial/ethnic backgrounds. Objective: The current study examined the relationship between both the level (severity) and pattern of race-based traumatic stress (RBTS) reactions and risky drinking. Participants: The current study sample was made up of 62 male (23.5%) and 202 female (76.5%) Latino/a/x, Black, and Asian college students attending a minority-serving institution. Methods: Study participants were asked to participate in an anonymous online survey. Results: A criterion profile analysis revealed that higher scores on RBTS reactions overall, and elevated scores on RBTS - avoidance, low self-esteem, and anger, specifically, were indicative of more risky drinking. Conclusions: These findings highlight a distinct pattern of RBTS scores that may predict a vulnerability to risky drinking and underscore the importance of racial trauma healing in alcohol use prevention and intervention efforts.
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Affiliation(s)
- Veronica E Johnson
- John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Kobi Chng
- John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Kellie Courtney
- John Jay College of Criminal Justice, City University of New York, New York, New York, USA
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Kiles TM, Hamilton LA, Hohmeier KC. "Following your dreams, and not killing yourself to do so": Black PharmDstudent perceptions of pharmacy residency. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100069. [PMID: 37316131 DOI: 10.1016/j.ajpe.2023.100069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Residency training is a key element of advancing the roles of pharmacists in patient care. Diversifying the healthcare workforce is also crucial in reducing health disparities and improving health equity.1 The objective of this study was to investigate Black Doctor of Pharmacy students' perceptions of pursuing pharmacy residency training to aid pharmacy educators in creating and improving structures to support the professional advancement of Black student pharmacists. METHODS A qualitative study employing focus groups was conducted at one of the top 20 colleges of pharmacy. Four focus groups consisting of Black students in years 2 through 4 of the Doctor of Pharmacy program were organized. A constructivist grounded theory approach2 was utilized to collect and analyze the data, which was organized into a conceptual framework. RESULTS The elements of the framework developed showcase Black students' consistent negotiation between personal well-being and pursuit of professional advancement. This framework also highlights how the experience of navigating personal wellness is unique for Black students, rather than simply a work/life balance concern. CONCLUSION The concepts in this framework may be valuable for colleges of pharmacy seeking to increase diversity in their residency pipeline. Targeted interventions to ensure adequate mentorship, mental health resources, diversity and inclusion efforts, and financial support will be necessary if the profession truly desires to expand increased diversity in clinical pharmacy.
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Affiliation(s)
- Tyler Marie Kiles
- Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center (UTHSC), College of Pharmacy, Memphis, TN, USA.
| | - Leslie A Hamilton
- Department of Clinical Pharmacy and Translational Science, UTHSC, College of Pharmacy, Knoxville, TN, USA
| | - Kenneth C Hohmeier
- Department of Clinical Pharmacy and Translational Science, UTHSC, College of Pharmacy, Knoxville, TN, USA
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Reed BN, Lebovitz L, Layson-Wolf C. How Resilience and Wellness Behaviors Affected Burnout and Academic Performance of First-Year Pharmacy Students During COVID-19. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9022. [PMID: 35304414 PMCID: PMC10159515 DOI: 10.5688/ajpe9022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/14/2022] [Indexed: 05/06/2023]
Abstract
Objective. To determine whether students' levels of resilience and self-reported wellness behaviors predicted burnout and grade point average at the end of the first fall semester of the COVID-19 pandemic.Methods. We measured first-year students' resilience, burnout (exhaustion and disengagement), and self-reported wellness behaviors (sleep, nutrition, social time, and self-care activities) at the beginning and end of the fall 2020 semester of pharmacy school. We also collected students' demographic information and end-of-semester grade point average from their academic records. Using multivariable regression, we assessed whether students' resilience and wellness behaviors predicted burnout and grade point average at the end of the semester. We also assessed for changes in burnout and wellness behaviors over time.Results. Resilience was positively associated with older age and was lower among students of color. Exhaustion and disengagement were high at baseline and continued to worsen over time. Students' self-reported wellness behaviors also decreased over time, except for ratings of sleep adequacy. Resilience predicted lower levels of disengagement at the end of the semester, but its relationship with exhaustion was inconsistent. The only wellness behaviors associated with lower burnout were nutrition and sleep adequacy. Students' end-of-semester grade point average was also related to nutrition and sleep adequacy but not resilience or burnout.Conclusion. Resilience offered some protection from burnout, but its relationship to immutable factors suggests that individual-focused interventions to improve student well-being (eg, wellness behaviors such as mindfulness meditation) should be complemented by organizational support, especially for younger students and students of color.
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Affiliation(s)
- Brent N Reed
- University of Maryland, School of Pharmacy, Baltimore, Maryland
| | - Lisa Lebovitz
- University of Maryland, School of Pharmacy, Baltimore, Maryland
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