1
|
Edwell AA. Dear Black Folx in Academic Pediatrics. Acad Pediatr 2024; 24:179-181. [PMID: 37591341 DOI: 10.1016/j.acap.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Affiliation(s)
- April A Edwell
- Department of Pediatrics, Division of Critical Care, University of California, San Francisco.
| |
Collapse
|
2
|
Legha R, Mabeza RM. Ethical guidelines for antiracism work in medicine: lessons from the antiracist healing collaborative. MEDICAL HUMANITIES 2024; 50:103-108. [PMID: 38388183 DOI: 10.1136/medhum-2023-012761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/24/2024]
Abstract
An explosion of antiracism in medicine efforts have transpired since 2020. However, no ethical guidelines exist to guide them. This oversight is concerning because the racism and white supremacy rife within medicine can easily thwart them. This article addresses this gap by highlighting ethical guidelines for antiracism work in medicine. We present nine core tenets derived from our experience forming the Antiracist Healing Collaborative (AHC), a medical student-led initiative committed to developing bold and disruptive antiracist medical education content. Our lessons developing and implementing these tenets can guide other antiracism in medicine collaborations striving to promote liberation and healing, rather than recapitulating the racism and white supremacy culture embedded within medicine. We close by reflecting on how these tenets have steadied our recent decision to draw AHC to a close. They have allowed us to honour what we achieved together, strengthen the relationship that formed the foundation for our activism and bolster the shared antiracism mission that will guide our individual journeys moving forwards. The first of their kind, our ethical guidelines for antiracism work in medicine can facilitate greater recognition of the risks embedded in anti-oppression work transpiring in academic settings.
Collapse
Affiliation(s)
| | - Russyan Mark Mabeza
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
3
|
Iheagwara UK, Patel S, Diaz DA, Yom SS, Goodman KA, Barry PN. Promoting Women and Historically Excluded Minorities in Medicine as Essential Leaders of Research. Adv Radiat Oncol 2023; 8:101301. [PMID: 37457820 PMCID: PMC10344684 DOI: 10.1016/j.adro.2023.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
Women and historically excluded minorities are underrepresented in clinical research. At the ASTRO 2021 annual meeting, the authors reviewed several strategies to improve on this issue. Implementation of such strategies should not only improve their visibility but also provide increased opportunities for their advancement and work in clinical research.
Collapse
Affiliation(s)
- Uzoma K. Iheagwara
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Shilpen Patel
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Radiation Oncology, Good Samaritan Hospital, San Jose, California
| | - Dayssy A. Diaz
- Department of Radiation Oncology, The Ohio State University, Columbus, Ohio
| | - Sue S. Yom
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Karyn A. Goodman
- Department of Radiation Oncology, Icahn School of Medicine and Mt. Sinai, New York, New York
| | - Parul N. Barry
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| |
Collapse
|
4
|
O'Brien MT, Bullock JL, Minhas PK, Roman SA, Joshi P, Lupton KL, Hauer KE. From Eggshells to Action: A Qualitative Study of Faculty Experience Responding to Microaggressions Targeting Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S79-S89. [PMID: 37983400 DOI: 10.1097/acm.0000000000005424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Microaggressions targeting clinical learners cause harm and threaten learning. Clinical supervisors can be powerful allies by intervening when microaggressions occur. This study explored general and student-nominated skilled supervisors' perspectives on responding to microaggressions targeting clinical learners. METHOD This single-institution, qualitative study within a constructivist paradigm explored faculty supervisor experiences with bystander response to microaggressions targeting learners. Clinical supervisors in medicine and surgery departments and those across departments nominated by students as skilled microaggression responders were invited to discuss microaggression scenarios targeting students in semistructured focus groups in the U.S. in 2020-2021. Investigators applied the framework method of thematic analysis to identify themes. RESULTS Forty-two faculty (31 medicine and surgery ["general"], 11 "student-nominated" as skilled responders) joined 10 focus groups (6 "general," 3 "student-nominated," 1 mixed). Four themes characterized experiences responding to microaggressions targeting learners: bystander goals, noticing, acting, and continuous learning. Participants' response goals were protecting learners, safeguarding learning, and teaching microaggression response skills. Noticing was influenced by past experiences with microaggressions and acculturation to clinical environments. Bystander action stemmed from (1) microaggression type, (2) personal emotional vulnerability, (3) knowledge of student preferences for supervisor response, and (4) clinical and educational context. Bystander action was more common when participants regarded all microaggressions as harmful, understood student preferences for faculty response, expected to err (growth mindset), and framed microaggressions as opportunities for humble reflection, intellectual candor, and teaching. Microaggression response required continuous learning through informal and formal skills development. CONCLUSIONS Complex factors govern faculty bystander response to microaggressions targeting clinical learners. Efforts to strengthen faculty bystander response should incorporate skill-building around preemptive discussions with learners and using intellectual candor to promote psychological safety, learning, and bystander action. Additional investigation is needed on how to incorporate these skills into team workflows and to assess outcomes of specific response strategies.
Collapse
Affiliation(s)
- Meghan T O'Brien
- M.T. O'Brien is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0001-8741-2734
| | - Justin L Bullock
- J.L. Bullock was a third-year internal medicine resident, Department of Medicine, University of California, San Francisco, San Francisco, California, at the time of this study, and is now a fellow, Division of Nephrology, University of Washington School of Medicine, Seattle, Washington
| | - Prabhjot K Minhas
- P.K. Minhas was a fourth-year medical student, University of California, San Francisco, San Francisco, California, at the time of the study, and is now a first-year pediatrics resident, Boston Combined Residency Program in Pediatrics at Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
| | - Sanziana A Roman
- S.A. Roman is professor, Department of Surgery and Medicine, University of California, San Francisco, San Francisco, California
| | - Priya Joshi
- P. Joshi is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine L Lupton
- K.L. Lupton is professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/ORCID:0000-0002-8812-4045
| |
Collapse
|
5
|
Legha RK, Richards M, Mabeza RM, Gordon-Achebe K, Kataoka S. Teaching the Legacy of Slavery in American Medicine and Psychiatry to Medical Students: Feasibility, Acceptability, Opportunities for Growth. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11349. [PMID: 37766875 PMCID: PMC10520221 DOI: 10.15766/mep_2374-8265.11349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 09/29/2023]
Abstract
Introduction Understanding the legacy of slavery in the United States is crucial for engaging in anti-racism that challenges racial health inequities' root causes. However, few medical educational curricula exist to guide this process. We created a workshop illustrating key historical themes pertaining to this legacy and grounded in critical race theory. Methods During a preclinical psychiatry block, a second-year medical school class, divided into three groups of 50-60, attended the workshop, which comprised a 90-minute lecture, 30-minute break, and 60-minute small-group debriefing. Afterwards, participants completed an evaluation assessing self-reported knowledge, attitudes and beliefs, and satisfaction with the workshop. Results One hundred eighty students watched the lecture, 15 attended small-group debriefings, and 132 completed the survey. Seventy-six percent (100) reported receiving no, very little, or some prior exposure to the legacy of slavery in American medicine and psychiatry. Over 80% agreed or strongly agreed that the workshop made them more aware of this legacy and that the artwork, photographs, storytelling, and media (videos) facilitated learning. Qualitative feedback highlighted how the workshop improved students' knowledge about the legacy of slavery's presence in medicine and psychiatry. However, students criticized the lecture's scripted approach and requested more discussion, dialogue, interaction, and connection of this history to anti-racist action they could engage in now. Discussion Though this workshop improved awareness of the legacy of slavery, students criticized its structure and approach. When teaching this legacy, medical schools should consider expanding content, ensuring opportunities for discussion in safe spaces, and connecting it to immediate anti-racist action.
Collapse
Affiliation(s)
| | - Misty Richards
- Assistant Clinical Professor and Program Director, Child and Adolescent Psychiatry Fellowship, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine
| | | | - Kimberly Gordon-Achebe
- Assistant Clinical Professor and Program Director, Child and Adolescent Psychiatry Fellowship, Department of Psychiatry, University of Maryland School of Medicine
| | - Sheryl Kataoka
- Professor Emeritus and Associate Program Director, Child and Adolescent Psychiatry Fellowship, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine
| |
Collapse
|
6
|
Guevara JP, Aysola J, Wade R, Nfonoyim B, Qiu M, Reece M, Carroll KN. Diversity in the pediatric research workforce: a scoping review of the literature. Pediatr Res 2023; 94:904-914. [PMID: 37185966 PMCID: PMC10129297 DOI: 10.1038/s41390-023-02603-4] [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: 06/12/2021] [Revised: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
The purpose of this scoping review is to determine trends in racial and ethnic representation, identify barriers and facilitators to greater diversity, and assess strategies and interventions to advance diversity among those in the pediatric research workforce in the U.S. We conducted a scoping review of PubMed supplemented with the authors' personal library of papers published from January 1, 2010, to December 31, 2021. To be eligible, papers had to provide original data, be published in English, report information from a U.S. healthcare institution, and report on outcomes of interest relevant to the child health field. The diversity of faculty has modestly increased over the past decade but reflects a worsening representation compared to overall population trends. This slow increase reflects a loss of diverse faculty and has been referred to as a "leaky pipeline." Strategies to plug the "leaky pipeline" include greater investments in pipeline programs, implementation of holistic review and implicit bias training, development of mentoring and faculty programs targeted to diverse faculty and trainees, alleviation of burdensome administrative tasks, and creation of more inclusive institutional environments. Modest improvements in the racial and ethnic diversity of the pediatric research workforce were identified. However, this reflects worsening overall representation given changing U.S. population demographics. IMPACT: Racial and ethnic diversity in the pediatric research workforce has shown modest increases but worsening overall representation. This review identified barriers and facilitators at the intrapersonal, interpersonal, and institutional levels that impact BIPOC trainees and faculty career advancement. Strategies to improve the pathway for BIPOC individuals include greater investments in pipeline and educational programs, implementation of holistic review admissions and bias training, institution of mentoring and sponsorship, alleviation of burdensome administrative responsibilities, and creation of inclusive institutional climates. Future studies should rigorously test the effects of interventions and strategies designed to improve diversity in the pediatric research workforce.
Collapse
Affiliation(s)
- James P Guevara
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Jaya Aysola
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Wade
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Bianca Nfonoyim
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maylene Qiu
- Biotech Commons Library, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Reece
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kecia N Carroll
- Department of Pediatrics, Mt Sinai School of Medicine, New York, NY, USA
| |
Collapse
|
7
|
Legha RK, Martinek NN. White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse. MEDICAL HUMANITIES 2023; 49:142-146. [PMID: 36241381 DOI: 10.1136/medhum-2022-012398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/16/2023]
Abstract
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
Collapse
|
8
|
Anene E, Nallajerla M, Bath EPJ, Castillo EG. Revisiting Research Safety Protocols: The Urgency for Alternatives to Law Enforcement in Crisis Intervention. Psychiatr Serv 2023; 74:325-328. [PMID: 36004437 PMCID: PMC10027434 DOI: 10.1176/appi.ps.20220084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research safety protocols are ubiquitous in mental health research involving human subjects and have the potential to harm research participants from racial-ethnic minority populations. For mental health emergencies, such protocols commonly rely on law enforcement for crisis intervention. The authors review inequities experienced by individuals with mental illness in law enforcement encounters, especially Black, Latinx, and other minoritized populations. They then describe the development of a research safety protocol that uses community-based crisis intervention programs as alternatives to law enforcement and provide a roadmap for researchers and institutional review boards to revisit and revise their human subjects safety protocols.
Collapse
Affiliation(s)
- Esther Anene
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| | - Meghana Nallajerla
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| | - Eraka P J Bath
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| | - Enrico G Castillo
- Department of Psychology, Yale University, New Haven, Connecticut (Anene); Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Nallajerla); Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bath, Castillo)
| |
Collapse
|
9
|
Jefferies K, States C, MacLennan V, Helwig M, Gahagan J, Bernard WT, Macdonald M, Murphy GT, Martin-Misener R. Black nurses in the nursing profession in Canada: a scoping review. Int J Equity Health 2022; 21:102. [PMID: 35871077 PMCID: PMC9308111 DOI: 10.1186/s12939-022-01673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With migration occurring over a series of centuries, dating back to the 1600’s, the circumstance regarding Black people in Canada is a complex account. A plethora of social issues and the failure to adequately acknowledge and reconcile historical issues, has resulted in health inequity, disparities and knowledge gaps, related to the Black population in Canada. In nursing, historical records indicate a legacy of discrimination that continues to impact Black nurses. The profession has begun reckoning with anti-Black racism and the residual effects. This scoping review sought to chart the existing evidence on Black nurses in the nursing profession in Canada.
Methods
JBI methodology was used to search peer-reviewed evidence and unpublished gray literature. Sources were considered for inclusion based on criteria outlined in an a priori protocol focusing on: 1) Canada 2) Black nurses and 3) nursing practice. No restrictions were placed on date of publication and language was limited to English and French. All screening and extractions were completed by two independent reviewers.
Results
The database search yielded 688 records. After removing duplicates, 600 titles and abstracts were screened for eligibility and 127 advanced to full-text screening. Eighty-two full-text articles were excluded, for a total of 44 sources meeting the inclusion criteria. Seven sources were identified through gray literature search. Subsequently, 31 sources underwent data extraction. Of the 31 sources, 18 are research (n = 18), six are commentaries (n = 6); one report (n = 1) and six are classified as announcements, memoranda or policy statements (n = 6). The review findings are categorized into five conceptual categories: racism (n = 12); historical situatedness (n = 2); leadership and career progression (n = 7); immigration (n = 4); and diversity in the workforce (n = 4).
Conclusions
This review reveals the interconnectedness of the five conceptual categories. Racism was a prominent issue woven throughout the majority of the sources. Additionally, this review captures how racism is exacerbated by intersectional factors such as gender, class and nationality. The findings herein offer insight regarding anti-Black racism and discrimination in nursing as well as suggestions for future research including the use of diverse methodologies in different jurisdictions across the country. Lastly, the implications extend to the nursing workforce in relation to enhancing diversity and addressing the ongoing nursing shortage.
Collapse
|
10
|
Darby A, Cleveland Manchanda EC, Janeway H, Samra S, Hicks MN, Long R, Gipson KA, Chary AN, Adjei BA, Khanna K, Pierce A, Kaltiso SAO, Spadafore S, Tsai J, Dekker A, Thiessen ME, Foster J, Diaz R, Mizuno M, Schoenfeld E. Race, racism, and antiracism in emergency medicine: A scoping review of the literature and research agenda for the future. Acad Emerg Med 2022; 29:1383-1398. [PMID: 36200540 DOI: 10.1111/acem.14601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective was to conduct a scoping review of the literature and develop consensus-derived research priorities for future research inquiry in an effort to (1) identify and summarize existing research related to race, racism, and antiracism in emergency medicine (EM) and adjacent fields and (2) set the agenda for EM research in these topic areas. METHODS A scoping review of the literature using PubMed and EMBASE databases, as well as review of citations from included articles, formed the basis for discussions with community stakeholders, who in turn helped to inform and shape the discussion and recommendations of participants in the Society for Academic Emergency Medicine (SAEM) consensus conference. Through electronic surveys and two virtual meetings held in April 2021, consensus was reached on terminology, language, and priority research questions, which were rated on importance or impact (highest, medium, lower) and feasibility or ease of answering (easiest, moderate, difficult). RESULTS A total of 344 articles were identified through the literature search, of which 187 met inclusion criteria; an additional 34 were identified through citation review. Findings of racial inequities in EM and related fields were grouped in 28 topic areas, from which emerged 44 key research questions. A dearth of evidence for interventions to address manifestations of racism in EM was noted throughout. CONCLUSIONS Evidence of racism in EM emerged in nearly every facet of our literature. Key research priorities identified through consensus processes provide a roadmap for addressing and eliminating racism and other systems of oppression in EM.
Collapse
Affiliation(s)
- Anna Darby
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA
| | | | - Hannah Janeway
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Shamsher Samra
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Marquita Norman Hicks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ruby Long
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katrina A Gipson
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Brenda A Adjei
- National Cancer Institute Division of Cancer Control and Population Sciences, Bethesda, Maryland, USA
| | - Kajal Khanna
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ava Pierce
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheri-Ann O Kaltiso
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophia Spadafore
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Annette Dekker
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Molly E Thiessen
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jordan Foster
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rose Diaz
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Mikaela Mizuno
- University of California, Riverside School of Medicine, Riverside, California, USA
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| |
Collapse
|
11
|
Paradis KC, Ryan KA, Covington EL, Schmid S, Simiele SJ, Chapman CH, Castillo R, Moran JM, Matuszak MM, Bott-Kothari T, Balter JM, Jagsi R. Gender-Based Discrimination and Sexual Harassment in Medical Physics. Int J Radiat Oncol Biol Phys 2022; 116:314-327. [PMID: 36252781 DOI: 10.1016/j.ijrobp.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Gender-based discrimination and sexual harassment have been well-studied in the fields of science, technology, engineering, math, and medicine. However, less is known about these topics and their effect within the profession of medical physics. We aimed to better understand and clarify the views and experiences of practicing medical physicists and medical physics residents regarding gender-based discrimination and sexual harassment. METHODS AND MATERIALS We conducted in-depth, semistructured, and confidential interviews with 32 practicing medical physicists and medical physics residents across the United States. The interviews were broad and covered the topics of discrimination, mentorship, and work/life integration. All participants were associated with a department with a residency program accredited by the Commission on Accreditation of Medical Physics Education Programs and had appointments with a clinical component. RESULTS Participants shared views about gender-based discrimination and sexual harassment that were polarized. Some perceived that discrimination and harassment were a current concern within medical physics, while some either perceived that they were not a concern or that discrimination positively affected women and minoritized populations. Many participants shared personal experiences of discrimination and harassment, including those related to unequal compensation, discrimination against mothers, discrimination during the hiring process, gender-biased assumptions about behaviors or goals, communication biases, and overt and persistent sexual harassment. CONCLUSIONS There is an urgent need to acknowledge, better understand, and address gender-based discrimination and sexual harassment in the field of medical physics.
Collapse
|
12
|
Legha RK, Clayton A, Yuen L, Gordon-Achebe K. Nurturing Children's Mental Health Body and Soul: Confronting American Child Psychiatry's Racist Past to Reimagine Its Antiracist Future. Child Adolesc Psychiatr Clin N Am 2022; 31:277-294. [PMID: 35361365 DOI: 10.1016/j.chc.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper unpacks the legacy of racism and white supremacy in American child psychiatry, connecting them to current racist inequities, to reimagine an antiracist future for the profession, and to serve all children's mental health body and soul. History reveals how child psychiatry has neglected and even perpetuated the intergenerational trauma suffered by minoritized children and families. By refusing to confront racial injustice, it has centered on white children's protection and deleted their role in white supremacist violence. An antiracist future for the profession demands a profound historical reckoning and comprehensive reimagining, a process that this paper begins to unfold.
Collapse
Affiliation(s)
| | - Angélica Clayton
- Program in the History of Medicine and Science, Yale University, 320 York Street, New Haven, CT 06511, USA
| | - Lindsay Yuen
- University of California Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA 92617, USA
| | - Kimberly Gordon-Achebe
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, 701 West Pratt Street, 4th Floor, Baltimore, MD 21201, USA
| |
Collapse
|
13
|
Paradis KC, Ryan KA, Schmid S, Moran JM, Laucis A, Chapman CH, Bott-Kothari T, Prisciandaro JI, Simiele S, Balter JM, Matuszak MM, Narayana V, Jagsi R. A qualitative investigation of resilience and well-being among medical physics residents. J Appl Clin Med Phys 2022; 23:e13554. [PMID: 35128786 PMCID: PMC8906227 DOI: 10.1002/acm2.13554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/11/2021] [Accepted: 01/19/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Medical physics residents (MPRs) will define and shape the future of physics in medicine. We sought to better understand the residency experience, as related to resilience and well‐being, through the lens of current MPRs and medical physicists (MPs) working with residents. Methods and materials From February–May 2019, we conducted 32, 1‐h, confidential, semi‐structured interviews with MPs either currently enrolled in an accredited residency (n = 16) or currently employed by a department with an accredited residency (n = 16). Interviews centered on the topics of mentorship, work/life integration, and discrimination. Qualitative analysis methods were used to derive key themes from the interview transcripts. Results With regard to the medical physics residency experience, four key themes emerged during qualitative analysis: the demanding nature of medical physics residencies, the negative impacts of residency on MPRs during training and beyond, strategies MPRs use to cope with residency stress, and the role of professional societies in addressing residency‐related change. Conclusions Residency training is a stress‐inducing time in the path to becoming a board‐certified MP. By uncovering several sources of this stress, we have identified opportunities to support the resiliency and well‐being of MPs in training through recommendations by professional societies, programmatic changes, and interventions at the department and residency program director level for residency programs, as well as strategies that MPRs themselves can use to support well‐being on their career journey.
Collapse
Affiliation(s)
- Kelly C Paradis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kerry A Ryan
- Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Spencer Schmid
- Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jean M Moran
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anna Laucis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Terri Bott-Kothari
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joann I Prisciandaro
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samantha Simiele
- Department of Radiation Physics, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - James M Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vrinda Narayana
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
14
|
Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
Collapse
Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
15
|
White A, Thornton RLJ, Greene JA. Remembering Past Lessons about Structural Racism - Recentering Black Theorists of Health and Society. N Engl J Med 2021; 385:850-855. [PMID: 34469642 DOI: 10.1056/nejmms2035550] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alexandre White
- From the Department of History of Medicine (A.W., J.A.G.), the Department of Medicine (J.A.G.), and the Department of Pediatrics (R.L.J.T.), Johns Hopkins University School of Medicine, the Department of Sociology, Johns Hopkins University Krieger School of Arts and Sciences (A.W.), and the Department of Health, Society, and Behavior, Johns Hopkins Bloomberg School of Public Health (R.L.J.T.) - all in Baltimore
| | - Rachel L J Thornton
- From the Department of History of Medicine (A.W., J.A.G.), the Department of Medicine (J.A.G.), and the Department of Pediatrics (R.L.J.T.), Johns Hopkins University School of Medicine, the Department of Sociology, Johns Hopkins University Krieger School of Arts and Sciences (A.W.), and the Department of Health, Society, and Behavior, Johns Hopkins Bloomberg School of Public Health (R.L.J.T.) - all in Baltimore
| | - Jeremy A Greene
- From the Department of History of Medicine (A.W., J.A.G.), the Department of Medicine (J.A.G.), and the Department of Pediatrics (R.L.J.T.), Johns Hopkins University School of Medicine, the Department of Sociology, Johns Hopkins University Krieger School of Arts and Sciences (A.W.), and the Department of Health, Society, and Behavior, Johns Hopkins Bloomberg School of Public Health (R.L.J.T.) - all in Baltimore
| |
Collapse
|
16
|
Alspaugh A, Lanshaw N, Kriebs J, Van Hoover C. Universal Health Care for the United States: A Primer for Health Care Providers. J Midwifery Womens Health 2021; 66:441-451. [PMID: 34165238 DOI: 10.1111/jmwh.13233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
The United States is one of a very few high-income countries that does not guarantee every person the right to health care. Residents of the United States pay more out-of-pocket for increasingly worse outcomes. People of color, those who have lower incomes, and those who live in rural areas have less access to health care and are therefore at even greater risk for poor health. Universal health care, a term for various models of health care systems that provide care for every resident of a given country, will help move the United States toward higher quality, more affordable, and more equitable care. This article defines a reproductive justice and human rights foundation for universal health care, explores how health insurance has worked historically in the United States, identifies the economic reasons for implementing universal health care, and discusses international models that could be used domestically.
Collapse
Affiliation(s)
- Amy Alspaugh
- Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Nikki Lanshaw
- Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Jan Kriebs
- Midwifery Institute, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cheri Van Hoover
- Midwifery Institute, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
17
|
Vassantachart A, Hwang L, Vassantachart A, Jennelle R. Residency Match Trends, Racial Disparity, and Matching Amid a Pandemic. Adv Radiat Oncol 2021; 6:100620. [PMID: 33732958 PMCID: PMC7940782 DOI: 10.1016/j.adro.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Radiation oncology has been facing an evolving crisis in recruitment for several years, and the events of 2020 to 2021 will certainly add to that crisis with the urgency of addressing systemic racial injustice amid a global pandemic. The purpose of this study is to examine applicant data to gain insight on residency match trends and evaluate these findings within the backdrop of a novel match year. METHODS AND MATERIALS National Residency Matching Program (NRMP) data between 2009 and 2020 were assessed for the number of applicants, programs, and positions available, number of ranked applicants needed to fill positions, and successfully matched applicant data. Additionally, Electronic Residency Application Service data were evaluated for race/ethnicity identification among applicants. RESULTS The number of applicants who ranked radiation oncology as their preferred specialty has declined for 3 consecutive years from 223 in 2017 to 155 in 2020. In 2020 the applicant-to-position ratio was at an all-time low at 0.82, and the unmatched position rate increased to 18.5%. The percentage of Black or African American applicants applying to radiation oncology has also declined to 4.9%, and this population represents 7.2% of all applicants. The number of ranked applicants needed to fill the available radiation oncology PGY2 positions increased from 4.0 in 2010 to 6.0 in 2020. CONCLUSION Declining interest in radiation oncology among applicants, and an even further decline of black applicants, along with the challenges of interview and travel restrictions during the pandemic provide heightened concern for this year's match. Innovative efforts to expand the reach of radiation oncology to prospective applicants is needed to engage diverse, bright, and committed students for the continued progress of radiation oncology and most importantly, our patients.
Collapse
Affiliation(s)
- April Vassantachart
- Department of Radiation Oncology, LAC + USC Medical Center, Los Angeles, California
| | - Lindsay Hwang
- Department of Radiation Oncology, LAC + USC Medical Center, Los Angeles, California
| | | | - Richard Jennelle
- Department of Radiation Oncology, LAC + USC Medical Center, Los Angeles, California
| |
Collapse
|
18
|
Webber S, Schwartz A, Kemper KJ, Batra M, Mahan JD, Babal JC, Sklansky DJ. Faculty and Peer Support During Pediatric Residency: Association With Performance Outcomes, Race, and Gender. Acad Pediatr 2021; 21:366-374. [PMID: 32798725 DOI: 10.1016/j.acap.2020.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/24/2020] [Accepted: 08/08/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the association of resident perception of colleague and faculty support with performance, as measured by milestones-based competency scores, exploring associations between race and gender and perception of support and milestone scoring. METHODS Resident satisfaction was measured using an annual survey of residents at 49 pediatric residency programs in 2016, 2017, and 2018. Satisfaction with colleague and faculty support was measured using Likert scale survey questions. Pediatric Milestone Competency scores were obtained from the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Analysis included linear fixed-effects models to examine the relationship between support satisfaction, race, gender, and spring milestone scores. RESULTS Over 60% of eligible residents responded to the survey. The majority of residents were satisfied with colleague and faculty support, with those identifying as Asian or underrepresented in medicine (URM) reporting lower rates of satisfaction than White peers. Residents satisfied with colleague support had higher milestone scores compared to those with a neutral degree of satisfaction. Residents reporting dissatisfaction with colleague and faculty support had lower milestone scores in most competency domains. Residents identifying as URM had lower milestone scores than White residents, which was partially mediated by lower rates of support satisfaction. CONCLUSIONS Resident satisfaction with colleague and faculty support correlates with milestone performance. In particular, dissatisfied residents have lower scores than those who are neutral or satisfied. Racial inequities in resident milestone scores may be partially driven by lower rates of support satisfaction among underrepresented residents.
Collapse
Affiliation(s)
- Sarah Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (S Webber, JC Babal, and DJ Sklansky), Madison, Wis
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, College of Medicine, University of Illinois at Chicago (A Schwartz)
| | - Kathi J Kemper
- Department of Pediatrics, College of Medicine, The Ohio State University (KJ Kemper and JD Mahan), Columbus, Ohio
| | - Maneesh Batra
- Department of Pediatrics, University of Washington School of Medicine & Seattle Children's Hospital (M Batra), Seattle, Wash
| | - John D Mahan
- Department of Pediatrics, College of Medicine, The Ohio State University (KJ Kemper and JD Mahan), Columbus, Ohio
| | - Jessica C Babal
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (S Webber, JC Babal, and DJ Sklansky), Madison, Wis
| | - Daniel J Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health (S Webber, JC Babal, and DJ Sklansky), Madison, Wis.
| | | |
Collapse
|
19
|
Woolhandler S, Himmelstein DU, Ahmed S, Bailey Z, Bassett MT, Bird M, Bor J, Bor D, Carrasquillo O, Chowkwanyun M, Dickman SL, Fisher S, Gaffney A, Galea S, Gottfried RN, Grumbach K, Guyatt G, Hansen H, Landrigan PJ, Lighty M, McKee M, McCormick D, McGregor A, Mirza R, Morris JE, Mukherjee JS, Nestle M, Prine L, Saadi A, Schiff D, Shapiro M, Tesema L, Venkataramani A. Public policy and health in the Trump era. Lancet 2021; 397:705-753. [PMID: 33581802 DOI: 10.1016/s0140-6736(20)32545-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/22/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Steffie Woolhandler
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - David U Himmelstein
- School of Urban Public Health, City University of New York at Hunter College, New York, NY, USA; Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Sameer Ahmed
- Harvard Immigration and Refugee Clinical Program, Harvard Law School, Harvard University, Boston, MA, USA
| | - Zinzi Bailey
- Medical Oncology Division, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary T Bassett
- Francois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA
| | | | - Jacob Bor
- School of Public Health, Boston University, Boston, MA, USA
| | - David Bor
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Samantha Fisher
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | - Adam Gaffney
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Kevin Grumbach
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helena Hansen
- Research Theme in Translational Social Science and Health Equity, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Philip J Landrigan
- Program for Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA
| | | | - Martin McKee
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Danny McCormick
- Cambridge Health Alliance, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alecia McGregor
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Reza Mirza
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliana E Morris
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Medicine and Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Joia S Mukherjee
- Harvard Medical School, Harvard University, Boston, MA, USA; Partners in Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marion Nestle
- Department of Nutrition and Food Studies, New York University, New York, NY, USA
| | - Linda Prine
- Department of Family and Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Altaf Saadi
- Harvard Medical School, Harvard University, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Davida Schiff
- Harvard Medical School, Harvard University, Boston, MA, USA; Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Martin Shapiro
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lello Tesema
- Department of Public Health, Los Angeles County, Los Angeles, CA, USA
| | - Atheendar Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
20
|
Detchou DK, Onyewuenyi A, Reddy V, Boyke A, Mbabuike N, Ashley WW, Nduom EK. Letter: A Call to Action: Increasing Black Representation in Neurological Surgery. Neurosurgery 2021; 88:E469-E473. [PMID: 33611592 DOI: 10.1093/neuros/nyab057] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Donald K Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Alvin Onyewuenyi
- Chicago Medical School Rosalind Franklin University of Medicine and Science Chicago, Illinois, USA
| | - Vamsi Reddy
- Medical College of Georgia Augusta University Augusta, Georgia, USA
| | - Andre Boyke
- Albert Einstein College of Medicine New York, New York, USA
| | - Nnenna Mbabuike
- Department of Neurological Surgery Ascension St. Mary's Hospital Saginaw, Michigan, USA
| | - William W Ashley
- Department of Neurological Surgery Sinai Hospital of Baltimore Baltimore, Maryland, USA
| | - Edjah K Nduom
- Surgical Neurology Branch National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, Maryland, USA.,Department of Neurosurgery Emory University School of Medicine Atlanta, Georgia, USA
| |
Collapse
|
21
|
Barceló NE, Shadravan S, Wells CR, Goodsmith N, Tarrant B, Shaddox T, Yang Y, Bath E, DeBonis K. Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:34-42. [PMID: 33111187 DOI: 10.1007/s40596-020-01327-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aims to evaluate the capacity of a holistic review process in comparison with non-holistic approaches to facilitate mission-driven recruitment in residency interview screening and selection, with particular attention to the promotion of race equity for applicants underrepresented in medicine (URM). METHODS Five hundred forty-seven applicants to a psychiatry residency program from US allopathic medical schools were evaluated for interview selection via three distinct screening rubrics-one holistic approach (Holistic Review; HR) and two non-holistic processes: Traditional (TR) and Traditional Modified (TM). Each applicant was assigned a composite score corresponding to each rubric, and the top 100 applicants in each rubric were identified as selected for interview. Odds ratios (OR) of selection for interview according to URM status and secondary outcomes, including clinical performance and lived experience, were measured by analysis of group composition via univariate logistic regression. RESULTS Relative to Traditional, Holistic Review significantly increased the odds of URM applicant selection for interview (TR-OR: 0.35 vs HR-OR: 0.84, p < 0.01). Assigning value to lived experience and de-emphasizing USMLE STEP1 scores contributed to the significant changes in odds ratio of interview selection for URM applicants. CONCLUSIONS Traditional interview selection methods systematically exclude URM applicants from consideration without due attention to applicant strengths or potential contribution to clinical care. Conversely, holistic screening represents a structural intervention capable of critically examining measures of merit, reducing bias, and increasing URM representation in residency recruitment, screening, and selection.
Collapse
Affiliation(s)
| | | | | | - Nichole Goodsmith
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | | | - Trevor Shaddox
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Yvonne Yang
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Eraka Bath
- University of California, Los Angeles, Los Angeles, CA, USA
| | | |
Collapse
|
22
|
Heard-Garris N, Boyd R, Kan K, Perez-Cardona L, Heard NJ, Johnson TJ. Structuring Poverty: How Racism Shapes Child Poverty and Child and Adolescent Health. Acad Pediatr 2021; 21:S108-S116. [PMID: 34740417 PMCID: PMC8574214 DOI: 10.1016/j.acap.2021.05.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 01/01/2023]
Abstract
Black, Native, and Latinx populations represent the racial and ethnic groups most impacted by poverty. This unequal distribution of poverty must be understood as a consequence of policy decisions-some that have sanctioned violence and others that have created norms-that continue to shape who has access to power, resources, rights, and protections. In this review, we draw on scholarship from multiple disciplines, including pediatrics, public health, environmental health, epidemiology, social and biomedical science, law, policy, and urban planning to explore the central question-What is the relationship between structural racism, poverty, and pediatric health? We discuss historic and present-day events that are critical to the understanding of poverty in the context of American racism and pediatric health. We challenge conventional paradigms that treat racialized poverty as an inherent part of American society. We put forth a conceptual framework to illustrate how white supremacy and American capitalism drive structural racism and shape the racial distribution of resources and power where children and adolescents live, learn, and play, ultimately contributing to pediatric health inequities. Finally, we offer antipoverty strategies grounded in antiracist practices that contend with the compounding, generational impact of racism and poverty on heath to improve child, adolescent, and family health.
Collapse
Affiliation(s)
- Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris and K Kan), Chicago, Ill; Northwestern University Feinberg School of Medicine (N Heard-Garris and K Kan), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris, K Kan, and L Perez-Cardona), Chicago, Ill.
| | - Rhea Boyd
- Palo Alto Medical Foundation (R Boyd), San Francisco, Calif
| | - Kristin Kan
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris and K Kan), Chicago, Ill; Northwestern University Feinberg School of Medicine (N Heard-Garris and K Kan), Chicago, Ill; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris, K Kan, and L Perez-Cardona), Chicago, Ill
| | - Leishla Perez-Cardona
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago (N Heard-Garris, K Kan, and L Perez-Cardona), Chicago, Ill
| | - Nevin J Heard
- College of Education, Roosevelt University (N Heard), Chicago, Ill
| | - Tiffani J Johnson
- Department of Emergency Medicine, University of California, Davis (TJ Johnson), Sacramento, Calif
| |
Collapse
|
23
|
Kamran SC, Yerramilli D, Vapiwala N. No Talent Left Behind: A Silver Lining for Diversity in Radiation Oncology in the Post-Coronavirus Disease 2019 (COVID-19) Era. Int J Radiat Oncol Biol Phys 2020; 108:472-474. [PMID: 32890536 PMCID: PMC7462790 DOI: 10.1016/j.ijrobp.2020.05.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
24
|
Ramos E. Genetic Counseling, Personalized Medicine, and Precision Health. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036699. [PMID: 31570377 DOI: 10.1101/cshperspect.a036699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Millions of individuals in the United States will have their exomes and genomes sequenced over the next 5 years as the use of genomic sequencing technologies in clinical care grows and as initiatives in personalized medicine and precision health move forward. As a result, we will see a shift away from the patient population of early adopters who pursued direct-to-consumer (DTC) testing and paid thousands of dollars to get their genomes sequenced and toward a different and more diverse set of test takers. Early data suggest that these individuals will have different motivations for pursuing genomic sequencing and will be less knowledgeable about and less confident of the benefits of genetic testing. To serve this growing population, genetic counselors must understand our future patients as well as the changing landscape of genomic testing, DTC offerings, and population sequencing initiatives.
Collapse
Affiliation(s)
- Erica Ramos
- Director, Clinical and Product Development, Geisinger National Precision Health, Geisinger Health System, North Bethesda, Maryland 20852, USA
| |
Collapse
|
25
|
Likis FE. Black Lives Matter: A Message from the Editor-in-Chief. J Midwifery Womens Health 2020; 65:459-461. [PMID: 32841487 DOI: 10.1111/jmwh.13156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022]
|
26
|
Doll KM, Thomas CR. Structural Solutions for the Rarest of the Rare - Underrepresented-Minority Faculty in Medical Subspecialties. N Engl J Med 2020; 383:283-285. [PMID: 32668121 DOI: 10.1056/nejmms2003544] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kemi M Doll
- From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine and Seattle Cancer Care Alliance, Seattle (K.M.D.); and the Department of Radiation Medicine, Oregon Health and Sciences University, Portland (C.R.T.)
| | - Charles R Thomas
- From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington School of Medicine and Seattle Cancer Care Alliance, Seattle (K.M.D.); and the Department of Radiation Medicine, Oregon Health and Sciences University, Portland (C.R.T.)
| |
Collapse
|
27
|
Affiliation(s)
- Rachel R Hardeman
- From the Division of Health Policy and Management, University of Minnesota School of Public Health (R.R.H.), Park Nicollet Clinic and the Department of Family Medicine and Community Health, University of Minnesota Medical School (E.M.M.) - all in Minneapolis; and the Palo Alto Medical Foundation, Palo Alto, CA (R.W.B.)
| | - Eduardo M Medina
- From the Division of Health Policy and Management, University of Minnesota School of Public Health (R.R.H.), Park Nicollet Clinic and the Department of Family Medicine and Community Health, University of Minnesota Medical School (E.M.M.) - all in Minneapolis; and the Palo Alto Medical Foundation, Palo Alto, CA (R.W.B.)
| | - Rhea W Boyd
- From the Division of Health Policy and Management, University of Minnesota School of Public Health (R.R.H.), Park Nicollet Clinic and the Department of Family Medicine and Community Health, University of Minnesota Medical School (E.M.M.) - all in Minneapolis; and the Palo Alto Medical Foundation, Palo Alto, CA (R.W.B.)
| |
Collapse
|
28
|
Deville C, Cruickshank I, Chapman CH, Hwang WT, Wyse R, Ahmed AA, Winkfield KM, Thomas CR, Gibbs IC. I Can't Breathe: The Continued Disproportionate Exclusion of Black Physicians in the United States Radiation Oncology Workforce. Int J Radiat Oncol Biol Phys 2020; 108:856-863. [PMID: 32668279 PMCID: PMC7354371 DOI: 10.1016/j.ijrobp.2020.07.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/05/2022]
Abstract
Purpose Black physicians remain disproportionately underrepresented in certain medical specialties, yet comprehensive assessments in radiation oncology (RO) are lacking. Our purpose was to report current and historical representation trends for Black physicians in the US RO workforce. Methods and Materials Public registries were used to assess significant differences in 2016 representation for US vs RO Black academic full-time faculty, residents, and applicants. Historical changes from 1970 to 2016 were reported descriptively. Linear regression was used to assess significant changes for Black residents and faculty from 1995 to 2016. Results In 2016, Black people represented 3.2% vs 1.5% (P < .001), 5.6% vs 3.2% (P = .005), and 6.5% vs 5.4% (P = .352) of US vs RO faculty, residents, and applicants, respectively. Although RO residents nearly doubled from 374 (1974) to 720 (2016), Black residents peaked at 31 in 1984 (5.9%; 31 of 522) and fell to 23 (3.2%; 23 of 720) in 2016 across 91 accredited programs; Black US graduate medical education trainees nearly doubled over the same period: 3506 (1984) to 6905 (2016). From 1995 to 2016, Black US resident representation significantly increased by 0.03%/y, but decreased significantly in RO by –0.20%/y before 2006 and did not change significantly thereafter. Over the same period, Black US faculty representation significantly increased by 0.02%/y, whereas Black RO faculty significantly increased by 0.07%/y before 2006, then decreased significantly by –0.16%/y thereafter. The number of Black RO faculty peaked at 37 in 2006 (3.1%; 37 of 1203) and was 27 (1.5%; 27 of 1769) in 2016, despite the nearly 1.5-fold increase in the number of both RO faculty and Black US faculty overall (4169 in 2006 and 6047 in 2016) during that period. Conclusions Black physicians remain disproportionately underrepresented in RO despite an increasing available pipeline in the US physician workforce. Deliberate efforts to understand barriers to specialty training and inclusion, along with evidence-based targeted interventions to overcome them, are needed to ensure diversification of the RO physician workforce.
Collapse
Affiliation(s)
- Curtiland Deville
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland.
| | | | - Christina H Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Wei-Ting Hwang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rhea Wyse
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Awad A Ahmed
- Department of Radiation Oncology, MercyOne Waterloo Medical Center, Waterloo, Iowa
| | - Karen M Winkfield
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California
| |
Collapse
|
29
|
Chapman CH, Gabeau D, Pinnix CC, Deville C, Gibbs IC, Winkfield KM. Why Racial Justice Matters in Radiation Oncology. Adv Radiat Oncol 2020; 5:783-790. [PMID: 32838067 PMCID: PMC7340406 DOI: 10.1016/j.adro.2020.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022] Open
Abstract
Recent events have reaffirmed that racism is a pervasive disease plaguing the United States and infiltrating the fabric of this nation. As health care professionals dedicated to understanding and alleviating disease, many radiation oncologists have failed to acknowledge how structural racism affects the health and well-being of the patients we aim to serve. The literature is full of descriptive statistics showing the higher incidence and mortality experienced by the Black population for health conditions ranging from infant mortality to infectious disease, including coronavirus disease 2019 (COVID-19). Acknowledgment that the root of health disparities experienced by Black people in this country are based in racism is essential to moving the nation and the field of radiation oncology forward. With this lens, a brief overview of structural and institutional racism shapes a discussion of what radiation oncologists and the organizations that represent them can do to address this scourge. As members of a technological field, we often harness the power of data to advance human health and approach challenging diseases with optimism that multidisciplinary effort can produce cure. A few principles to mitigate the longstanding issues of Black marginalization within the field have been recommended via the ATIP (Acknowledgment, Transparency, Intentionality, and rePresentation) and LEADS (Learn, Engage, Advocate, Defend, Support) approaches. However, additional introspection is encouraged. Just as individuals, practices, and organizations rallied to determine how best to address the issues related to the COVID-19 pandemic, the same investigational fervor must be applied to the issue of racism to combat this sinister and often deadly disease.
Collapse
Affiliation(s)
- Christina Hunter Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Darlene Gabeau
- Department of Radiation Oncology, William E. Kahlert Regional Cancer Center, Lifebridge Health, Westminster, Maryland
| | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Iris C Gibbs
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Karen M Winkfield
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| |
Collapse
|
30
|
Perez NP, Stapleton SM, Tabrizi MB, Watkins MT, Lillemoe KD, Kelleher CM, Chang DC. The impact of race on choice of location for elective surgical care in New York city. Am J Surg 2020; 219:557-562. [PMID: 32007235 DOI: 10.1016/j.amjsurg.2020.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/07/2019] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.
Collapse
Affiliation(s)
- Numa P Perez
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA.
| | - Sahael M Stapleton
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Maryam B Tabrizi
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael T Watkins
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA
| | - Keith D Lillemoe
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA
| | - Cassandra M Kelleher
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA
| | - David C Chang
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, Boston, MA, 02114, USA; Massachusetts General Hospital, Codman Center for Clinical Effectiveness in Surgery, Charles River Plaza, Suite 403, 165 Cambridge Street, Boston, MA, 02114, USA
| |
Collapse
|
31
|
Affiliation(s)
- Esther K Choo
- Center for Policy and Research in Emergency Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
| |
Collapse
|