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Vail EA, Ackland GL. The BJA Editorial Fellowship 2024: a barometer for the state of academic anaesthesiology, perioperative, pain, and critical care medicine. Br J Anaesth 2024; 133:3-6. [PMID: 38744551 DOI: 10.1016/j.bja.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 05/16/2024] Open
Abstract
Throughout its 100-yr history, a key ambition of the British Journal of Anaesthesia has been to foster our academic community by addressing the needs of individuals in the early stages of their independent clinical and research careers. Longitudinal mentoring and peer networking are critical for establishing a community of like-minded peers and mentor-advisors required to navigate the challenges of academic medicine. In 2019, the Journal launched an Editorial Fellowship scheme, aimed at comprehensively demystifying the process of peer review, editing, and publishing through guided mentorship and experiential learning.
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Affiliation(s)
- Emily A Vail
- Penn Center for Perioperative Outcomes Research and Transformation, Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Gareth L Ackland
- Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
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Koch AR, Craemer KA, Garland CE, Fox WB, Jones CT, Qualls AC, Sterr JC, Geller SE. Federally Funded Randomized Controlled Trials Increase Analysis and Reporting of Study Outcomes by Sex, Race, and Ethnicity. J Womens Health (Larchmt) 2024; 33:14-19. [PMID: 37930690 DOI: 10.1089/jwh.2023.0307] [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: 11/07/2023] Open
Abstract
Background: We previously examined National Institutes of Health (NIH)-funded randomized controlled trials (RCTs) published in 2004, 2009, and 2015 and found low compliance with NIH policies on inclusion, analysis, and reporting results for female and minoritized subgroups, with no improvement over time. We conducted a fourth wave of data collection using RCTs published in 2021, comparing current results with previous years. Materials and Methods: The authors used PubMed to find 657 RCTs published in print in 14 leading US medical journals in 2021. Of those, 93 (14.2%) were eligible for analysis. We reviewed all parts of eligible studies and any published commentary. Fisher's exact statistics compared proportions of studies analyzing or reporting results for subgroups in 2021 compared with RCTs studied in previous waves. Posthoc analysis compared eligible RCTs about the Covid-19 pandemic to eligible RCTs on other topics. Results: Twenty-five of 93 studies (26.9%) analyzed or reported outcomes by race or ethnicity, an increase over previous years (p < 0.01). Among 79 RCTs with participants of both sexes, the median proportion of female participants was 43%. Moreover, 34 (43.0%) reported an outcome by sex, included sex as a covariate in statistical analysis, or reported results by sex, also an increase over previous waves (p < 0.01). Eleven eligible studies (11.8%) were on a SARS-CoV-2 topic; there was no difference between SARS-CoV-2 RCTs and RCTs on other topics. Conclusions: Analysis and reporting by sex, race, and ethnicity for NIH-funded RCTs published in 2021 significantly increased from previous waves, despite no corresponding increase in enrollment.
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Affiliation(s)
- Abigail R Koch
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
| | - Katherine A Craemer
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
| | - Caitlin E Garland
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
| | - William B Fox
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Cyndra T Jones
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Ashley C Qualls
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Julia C Sterr
- University of Illinois College of Medicine Rockford, Rockford, Illinois, USA
| | - Stacie E Geller
- Center for Research on Women and Gender, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
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Edwell A, Van Schaik S, Teherani A. URM: Underrepresented or Underrecognized? A Case Study of Black Pediatric Critical Care Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S50-S57. [PMID: 37983396 DOI: 10.1097/acm.0000000000005370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE This study explored Black physicians' experience via an antideficit lens to gain new ideas for advancing minoritized physicians in academic medicine more broadly. Increasingly, systemic racism in academic medicine is intentionally acknowledged and named. However, many solutions to tackle racism and the overall paucity of Black physicians use a deficit framing, painting Black physicians and trainees as lacking preparation, interest, or experience and qualifications. Such solutions aim to help Black people assimilate into the "White Space" of academic medicine, rather than focusing on Black people's strengths. METHOD This qualitative study included 15 Black physicians and trainees in pediatric critical care medicine (PCCM) from across the country who participated in semistructured interviews. Through an antideficit lens, the researchers examined the social, cultural, and structural contexts influencing the participants' individual experiences. They analyzed the data combining thematic and narrative qualitative analysis approaches, including restorying. RESULTS The data help promote understanding of the landscape and context in which Black PCCM physicians become successful. Achievement took on different forms for the participants. Participants described enablers of achievement that supported them through their individual journeys spanning 3 general domains-intrinsic, interpersonal, and systemic. Three additional enablers were tied specifically to participants' Black identities-harnessing Blackness as a superpower, leaning in to lead, and successfully navigating the "unwritten rules." CONCLUSIONS By using an antideficit framework, this study delineates and centers participants' ingenuity in cultivating repertoires of practice that enabled them to succeed, despite challenges rooted in systemic racism. Going forward, rather than focus solely on what is missing, academic medicine should try to shift systems and regularly recognize and value the knowledge, expertise, and merit Black that physicians bring. Perhaps an appropriate framing is not that Black physicians are underrepresented in medicine; maybe instead, it is that they are underrecognized.
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Affiliation(s)
- April Edwell
- A. Edwell is assistant professor of pediatrics, Department of Pediatrics, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Sandrijn Van Schaik
- S. Van Schaik is professor of pediatrics, Department of Pediatrics, Division of Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Arianne Teherani
- A. Teherani is professor of medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-983
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Lusk P. Emotion, ethics, epistemology: What can shame 'do' in medical education? J Eval Clin Pract 2023; 29:1135-1142. [PMID: 36317709 DOI: 10.1111/jep.13782] [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: 04/22/2022] [Revised: 08/22/2022] [Accepted: 10/04/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND Recent empirical studies have described and theorized a culture of shame within medical education in the Anglo-American context (Bynum). Shame is universal and highly social human emotion characterized by a sense of feeling objectified and judged negatively, in contrast to one's own self-concept. Shame has both an embodied and a relational dimension. Shame is considered especially relevant in healthcare settings (Dolezal and Lyons), and the tenets of patient care within the medical profession include respecting the dignity and upholding the safety of patients. However, shame is frequently deployed as a teaching tool within medical training. METHOD Here I ask, what can shame do in medical education (Ahmed)? What epistemic and relational conditions does it construct? I draw from philosophical voices in higher education to illuminate how shaming practices in medical education can undermine dignity safety (Callan), preclude inclusivity, and in the context of the hierarchical and marginalizing medical system, propagate epistemic injustice (Fricker). DISCUSSION This argument shows how shame in education can be both phenomenologically and normatively problematic and may act differently upon students who experience marginalization and those who are majoritized. I further suggest that a medical education system which upholds the epistemological and relational frameworks of power, shame, and epistemic injustice, underscores those frameworks in the medical system at large, disserving individual patients who are already at risk of suffering epistemic injustice (Carel), and society at large. CONCLUSION This analysis of shame in medical education focuses on the highly relational and interpersonal elements of learning to live and work in the medical system, highlighting the need for respect, trust, and resistance to reorient the relational learning environment toward individual and systemic forms of justice.
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Affiliation(s)
- Penelope Lusk
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Szoko N, Ragunanthan B, Radovic A, Garrison JL, Torres O. Antiracist Curriculum Implementation for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162986. [PMID: 37123077 PMCID: PMC10134181 DOI: 10.1177/23821205231162986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents. Methods In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation. Results Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy. Conclusion We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Nicholas Szoko, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Avenue, Second Floor, Pittsburgh PA, 15213, USA.
| | | | - Ana Radovic
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Garrison
- Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Orquidia Torres
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Simpson T, Evans J, Goepfert A, Elopre L. Implementing a graduate medical education anti-racism workshop at an academic university in the Southern USA. MEDICAL EDUCATION ONLINE 2022; 27:1981803. [PMID: 34813390 PMCID: PMC8635611 DOI: 10.1080/10872981.2021.1981803] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) and the social justice movement in early 2020 awakened many Americans to the health disparities and health care inequities affecting Black communities. This heightened awareness has strengthened the call to address social determinants of health, like racism. Physicians can play an important role in dismantling racism through knowledge of implicit biases and understanding of historical trauma resulting in medical distrust as a crucial step to help advance the health of minority communities. The purpose of this project was to develop an anti-racism workshop for Graduate Medical Education. Two discussants led 1.5-hour interactive workshops. Content covered microagressions, colorblindness, tokenism, stereotypes, levels of racism, the impact of racism on health, and anti-racism concepts. Facilitated breakout sessions allowed participants to provide examples of witnessed racism and discuss application of anti-racism tools in those settings. Following the workshops, participants were asked to complete a 16-item survey to evaluate workshop effectiveness. Between July and August 2020, four workshops were delivered to 131 attendees. Fifty-nine completed post workshop surveys. Most respondents were White (75%), female (63%), and aged 31-40 (29%). Over half were faculty; 24% were residents, 8% fellows. The majority agreed they could apply knowledge to their work (95%) and found the workshop useful (95%). Over two-thirds reported being able to better identify disparities and better identify and communicate about racism. In open-ended questions, many participants requested an interactive longitudinal curriculum. Developing an antiracism workshop for an academic medical center located in the Deep South provided more insight into tangible next steps to foster an institutional culture centered on antiracism.
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Affiliation(s)
- Tina Simpson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Justin Evans
- Department of Medicine USA, University of Alabama at Birmingham, Birmingham, USA
| | - Alice Goepfert
- Department of Obstetrics/Gynecology, University of Alabama at Birmingham, Birmingham, USA
| | - Latesha Elopre
- Department of Medicine USA, University of Alabama at Birmingham, Birmingham, USA
- CONTACT Latesha Elopre Department of Medicine USA, University of Alabama at Birmingham, 845 19 Street South, BBRB 206, Birmingham, AL35205, USA
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7
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Jones DD. Dismantling Institutional Racism: The Role of Behavioral Science. Int J Psychiatry Med 2022; 57:373-380. [PMID: 35950989 DOI: 10.1177/00912174221111661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Institutionalized racism embeds our systems of healthcare delivery and medical education. This produces racial healthcare disparities which have been shown to severely impact both physical and behavioral health outcomes. Efforts to address institutionalized racism often focus on individualized efforts directed towards the healthcare workforce. However, more effective system level approaches are emerging. The behavioral health sciences can play a role in dismantling institutionalized racism by providing the evidence needed to understand effects on individuals and develop targeted system level approaches.
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Burnett-Bowie SAM, Zeidman JA, Soltoff AE, Carden KT, James AK, Armstrong KA. Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study. J Gen Intern Med 2022; 37:2337-2344. [PMID: 35157198 PMCID: PMC9360374 DOI: 10.1007/s11606-021-07385-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Racism negatively impacts health and well-being. Members of the medical community must intervene to address racism. OBJECTIVE To assess whether attitudes about the impact of racism on health or society are associated with intervening around racism. DESIGN Cross-sectional survey of a large department of medicine in an urban academic setting. PARTICIPANTS Interns, residents, fellows, and faculty. MAIN MEASURES The primary outcome was the likelihood of intervening around an observed racist encounter or a racist policy. Predictor variables included age, gender identity, race/ethnicity, and attitudes about racism. KEY RESULTS Although the majority of the 948 respondents endorsed the impact of racism on health and other societal effects, levels of endorsement were lower among older individuals, or those reporting male gender identity or selecting other race. Higher endorsement of the impact of racism on health was associated with increased odds of speaking up about a racist encounter or racist policy, with odds ratios from 1.18 to 1.30 across scenarios. Likelihood of speaking up about racism did not differ by racial or ethnic group, but older individuals were generally more likely to speak up and individuals between 20 and 29 years of age were more likely to speak with someone other than leadership or the source of a racist encounter. CONCLUSIONS Awareness of the effects of racism on health is associated with increased likelihood of intervening when a racist encounter is observed or a racist policy is noted. Including information on the impact of racism on health and creating safe spaces to discuss racism may increase the likelihood of bystander intervention in anti-racism strategies.
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Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA, 02114-2696, USA.
| | - Jessica A Zeidman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander E Soltoff
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kylee T Carden
- Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aisha K James
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Katrina A Armstrong
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Rosario J, Lewiss RE, Stolz LA, Del Rios M, Acuña J, Adhikari S, Amponsah D, Dessie AS, Gottlieb M, Huang RD, Jones J, Landry A, Liu RB, Ng L, Panebianco NL, Weekes AJ, Knight S. Creating a more racial-ethnic inclusive clinical ultrasound community. Am J Emerg Med 2022; 54:208-211. [PMID: 35176660 PMCID: PMC8824357 DOI: 10.1016/j.ajem.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Javier Rosario
- University of Central Florida, Department of Emergency Medicine, Orlando, FL, United States of America.
| | - Resa E Lewiss
- Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, PA, United States of America
| | - Lori A Stolz
- University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH, United States of America
| | - Marina Del Rios
- University of Iowa, Department of Emergency Medicine, Iowa City, IA, United States of America
| | - Josie Acuña
- University of Arizona, Department of Emergency Medicine, Tucson, AZ, United States of America
| | - Srikar Adhikari
- University of Arizona, Department of Emergency Medicine, Tucson, AZ, United States of America
| | - David Amponsah
- Henry Ford Hospital, Department of Emergency Medicine, Detroit, MI, United States of America
| | - Almaz S Dessie
- Columbia University Vagelos College of Physicians & Surgeons, Department of Emergency Medicine, New York, NY, United States of America
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, IL, United States of America
| | - Robert D Huang
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, MI, United States of America
| | - Jodi Jones
- UT Southwestern Medical Center, Department of Emergency Medicine, Dallas, TX, United States of America
| | - Adaira Landry
- Harvard Medical School, Brigam and Women's Hospital, Department of Emergency Medicine, Boston, MA, United States of America
| | - Rachel B Liu
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, United States of America
| | - Lorraine Ng
- Columbia University Vagelos College of Physicians & Surgeons, Department of Emergency Medicine, New York, NY, United States of America
| | - Nova L Panebianco
- University of Pennsylvania, Department of Emergency Medicine, Philadelphia, PA, United States of America
| | - Anthony J Weekes
- Carolinas Medical Center at Atrium Health, Department of Emergency Medicine, Charlotte, NC, United States of America
| | - Starr Knight
- University of California San Francisco, Department of Emergency Medicine, San Francisco, CA
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Rajaguru PP, Ademuwagun L, Pierre-Louis Y, Reddy NG, Moreira CC. Moving Beyond Diversity: A Scoping Review of Inclusion Initiatives in the Surgical Workforce. J Am Coll Surg 2022; 234:203-213. [PMID: 35213442 DOI: 10.1097/xcs.0000000000000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases (Medline, PubMed, Web of Science) were queried. Peer-reviewed full-text English-language articles focused on interventions or frameworks to achieve inclusion in the surgical workforce were considered. The initial search yielded 2243 papers; 15 met inclusion criteria. The published literature regarding interventions to achieve inclusion was sparse; the most common reasons for exclusion of full texts were papers not focused on interventions (42%; n = 51) or purely focused on diversity and representation (36%; n = 42). The most common field represented was broadly academic surgery (4/15; 47%), with seven other subspecialties represented. A small minority received funding (3/15; 20%). Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.
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Affiliation(s)
- Praveen P Rajaguru
- From the Supporting Underrepresented Research to Generate Equity (SURGE) Lab (Rajaguru, Ademuwagun, Pierre-Louis, Reddy, Moreira), The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lydia Ademuwagun
- From the Supporting Underrepresented Research to Generate Equity (SURGE) Lab (Rajaguru, Ademuwagun, Pierre-Louis, Reddy, Moreira), The Warren Alpert Medical School of Brown University, Providence, RI
| | - Youry Pierre-Louis
- From the Supporting Underrepresented Research to Generate Equity (SURGE) Lab (Rajaguru, Ademuwagun, Pierre-Louis, Reddy, Moreira), The Warren Alpert Medical School of Brown University, Providence, RI
| | - Neha G Reddy
- From the Supporting Underrepresented Research to Generate Equity (SURGE) Lab (Rajaguru, Ademuwagun, Pierre-Louis, Reddy, Moreira), The Warren Alpert Medical School of Brown University, Providence, RI
| | - Carla C Moreira
- From the Supporting Underrepresented Research to Generate Equity (SURGE) Lab (Rajaguru, Ademuwagun, Pierre-Louis, Reddy, Moreira), The Warren Alpert Medical School of Brown University, Providence, RI
- Division of Vascular Surgery, Department of Surgery (Moreira), The Warren Alpert Medical School of Brown University, Providence, RI
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Montoya-Williams D, Fraiman YS, Peña MM, Burris HH, Pursley DM. Antiracism in the Field of Neonatology: A Foundation and Concrete Approaches. Neoreviews 2022; 23:e1-e12. [PMID: 34970665 PMCID: PMC8796312 DOI: 10.1542/neo.23-1-e1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Neonatal patients and families from historically marginalized and discriminated communities have long been documented to have differential access to health care, disparate health care, and as a result, inequitable health outcomes. Fundamental to these processes is an understanding of what race and ethnicity represent for patients and how different levels of racism act as social determinants of health. The NICU presents a unique opportunity to intervene with regard to the detrimental ways in which structural, institutional, interpersonal, and internalized racism affect the health of newborn infants. The aim of this article is to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which health care professionals in the field of neonatology can contribute to antiracism and health equity in their professional careers.
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Affiliation(s)
| | - Yarden S Fraiman
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michelle-Marie Peña
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather H Burris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
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12
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Kiang MV, Tsai AC. Failure of leadership in U.S. academic medicine after George Floyd's killing by police and amidst subsequent unrest. Ann Epidemiol 2022; 65:116-119. [PMID: 34023486 PMCID: PMC8606007 DOI: 10.1016/j.annepidem.2021.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/15/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
The horrific nature of George Floyd's killing by a Minneapolis Police Department officer on May 25, 2020 sparked an enduring stretch of nationwide protests against police brutality and in support of the Black Lives Matter movement. During periods of crisis, anchor institutions may exert leadership by issuing public statements to communicate shared institutional values, enhance morale, and signal direction in the face of crisis. In our analysis of public statements issued by 56 leading U.S. medical schools, we found that nearly all identified George Floyd by name, and a majority noted the role of racism or acknowledged the Black community specifically. Fewer referenced the act resulting in Floyd's death or made explicit reference to the police. Far fewer explicitly used terms denoting active support, like "antiracism" or "Black Lives Matter." Only a minority of institutions made reference to the killing of George Floyd by the police, and most failed to address this country's targeted, historically engrained, and sustained oppression of Black people through white supremacy. Thus, there remain significant opportunities for U.S. medical schools to exert meaningful leadership in public health.
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Affiliation(s)
- Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA,Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA,Harvard Medical School, Boston, Massachusetts, USA,Correspondence: Alexander Tsai, MD, Center for Global Health, Massachusetts General Hospital, 125 Nashua Street, 7th floor, Boston, Massachusetts, 02114.
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13
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Ghassemi M, Nsoesie EO. In medicine, how do we machine learn anything real? PATTERNS 2022; 3:100392. [PMID: 35079713 PMCID: PMC8767288 DOI: 10.1016/j.patter.2021.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Machine learning has traditionally operated in a space where data and labels are assumed to be anchored in objective truths. Unfortunately, much evidence suggests that the “embodied” data acquired from and about human bodies does not create systems that function as desired. The complexity of health care data can be linked to a long history of discrimination, and research in this space forbids naive applications. To improve health care, machine learning models must strive to recognize, reduce, or remove such biases from the start. We aim to enumerate many examples to demonstrate the depth and breadth of biases that exist and that have been present throughout the history of medicine. We hope that outrage over algorithms automating biases will lead to changes in the underlying practices that generated such data, leading to reduced health disparities. Evidence indicates that data acquired from and about human bodies in medicine and health do not always create equitable systems. Bias is pervasive in clinical devices, interventions, and interactions. These include devices that are designed without regard for sex, gender, and skin color; interventions that embed race; disease diagnoses that hinge on gender or ethnicity; and biased interactions between patients and health workers. Data from these systems when used in machine learning algorithms will promote or exacerbate these biases. Often there is a lack of education in computer science about the systemic impact of gender discrimination, racism, and socioeconomic inequalities on data used in developing machine learning algorithms for health. The solutions to addressing these engrained biases are not easy and require intentional efforts by those who develop algorithms and those who use algorithms including, computer scientists, engineers, clinicians, healthcare institutions, and others. However, these solutions cannot exist without education about the historical injustices against marginalized groups, a refusal to accept inequities as the norm, and shouldering the responsibility to create and apply algorithms that reduce rather than promote inequity.
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Gilliam CA, Olszewski AE, McDade JE, Homer P, Grow HM, McPhillips HA, Rooholamini SN. Grounded in Justice: An Equity Framework for Chief Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1638-1642. [PMID: 34074897 DOI: 10.1097/acm.0000000000004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The 2019-2020 academic year was unprecedented, with navigating the COVID-19 pandemic and meaningfully engaging with the causes and consequences of long-standing racism and social injustice in the United States. In this article, the authors, all former chief residents, reflect on how they carried out their role during this last year using an approach that was grounded in equity and justice. They describe a framework based on their experiences, including setting the tone and culture of the residency program; providing medical education, teaching, and feedback; advocating for resident well-being and inclusion; participating in quality improvement and hospital policymaking; and partnering for institutional change. They end with a call to action to reconceptualize the role of the chief resident to include the genuine work of diversity, equity, and inclusion to ensure a more equitable future.
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Affiliation(s)
- Courtney A Gilliam
- C.A. Gilliam is a pediatric hospital medicine fellow, Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Aleksandra E Olszewski
- A.E. Olszewski is a pediatric bioethics fellow, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Jessica E McDade
- J.E. McDade is hospitalist, Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Paul Homer
- P. Homer is pediatric hospitalist, St. Joseph's Hospital, Bellingham, Washington
| | - H Mollie Grow
- H.M. Grow is associate professor, Department of Pediatrics, University of Washington School of Medicine, general pediatrics attending, continuity clinic director, and associate director, Pediatric Residency Program, Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Heather A McPhillips
- H.A. McPhillips is professor of pediatrics and director, Pediatric Residency Program, Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Sahar N Rooholamini
- S.N. Rooholamini is assistant professor, Department of Pediatrics, and associate director, Pediatric Residency Program, Seattle Children's Hospital/University of Washington, Seattle, Washington
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Burnett-Bowie SAM, Bachmann GA. Racism: the shameful practices that the medical profession is finally addressing. Womens Midlife Health 2021; 7:9. [PMID: 34727987 PMCID: PMC8561345 DOI: 10.1186/s40695-021-00068-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA, 02114-2696, USA.
| | - Gloria A Bachmann
- Women's Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Impact of Biases in Selection and Evaluation on the Composition of the Radiology Physician Workforce. Acad Radiol 2021; 28:916-921. [PMID: 33903012 DOI: 10.1016/j.acra.2021.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
Lack of diversity in Radiology is a public health problem and may be self perpetuating as diverse candidates view the field as hostile to their entry and advancement, and consequently do not apply into the field. Solutions require understanding the obstacles, which range from enrollment in medical school to achieving leadership positions in Radiology. An understanding of the effect of demographic data on diversity in Radiology, disparate effects of Step examinations, medical school grades and induction into academic honor societies, and existing faculty disparities will allow us to better recruit, train, and retain a diverse group of physicians in our field. The downstream effect of a diverse workforce is improvement in health outcomes and disparities in medical care for our communities.
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Thatipelli S, Osude N, Youmans QR. Towards Inclusion: a Guidebook for Championing Diversity for Internal Medicine Chief Medical Residents. J Gen Intern Med 2021; 36:1761-1764. [PMID: 33846941 PMCID: PMC8175528 DOI: 10.1007/s11606-021-06782-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Sneha Thatipelli
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Nkiru Osude
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Quentin R Youmans
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Madara J, Miyamoto S, Farley JE, Gong M, Gorham M, Humphrey H, Irons M, Mehrotra A, Resneck J, Rushton C, Shanafelt T. Clinicians and Professional Societies COVID-19 Impact Assessment: Lessons Learned and Compelling Needs. NAM Perspect 2021; 2021:202105b. [PMID: 34532690 PMCID: PMC8406512 DOI: 10.31478/202105b] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Jason E Farley
- Johns Hopkins University School of Nursing and Johns Hopkins University School of Medicine
| | - Michelle Gong
- Montefiore Medical Center and Albert Einstein College of Medicine
| | | | | | | | - Ateev Mehrotra
- Harvard Medical School and Beth Israel Deaconess Medical Center
| | | | - Cynda Rushton
- Johns Hopkins School of Medicine, Berman Institute of Bioethics and School of Nursing
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Mahabir DF, O’Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Experiences of everyday racism in Toronto's health care system: a concept mapping study. Int J Equity Health 2021; 20:74. [PMID: 33691682 PMCID: PMC7943708 DOI: 10.1186/s12939-021-01410-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/14/2021] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.
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Affiliation(s)
- Deb Finn Mahabir
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada
| | - Aisha Lofters
- Women’s College Hospital, 76 Grenville St., Toronto, M5S 1B2 Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5 Canada
| | - Christina Salmon
- Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1T8 Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7 Canada
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Affiliation(s)
- Altha J Stewart
- Division of Social and Community Psychiatry and Center for Health in Justice Involved Youth, University of Tennessee Health Science Center, Memphis. Dr. Stewart served as the 145th President of the American Psychiatric Association (2018-2019)
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Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211049482. [PMID: 37089985 PMCID: PMC9978668 DOI: 10.1177/26334895211049482] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - April Oh
- Division of Cancer Control and Population Sciences, Implementation
Science Team, National Cancer Institute, Rockville, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical
Center, New York, USA
| | - Derek M. Griffith
- Georgetown University, Racial Justice Institute, Washington,
USA
- Georgetown University, Center for Men’s Health Equity, Washington,
USA
- Department of Health Systems Administration at the School of Nursing
& Health Studies, Georgetown University, Washington, USA
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Rattani A. Interpersonal Racism in the Healthcare Workplace: Examining Insidious Collegial Interactions Reinforcing Structural Racism. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:307-314. [PMID: 34924056 DOI: 10.1017/jme.2021.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The traumatic stress experienced by our black healthcare colleagues is often overlooked. This work contextualizes workplace racism, identifies some interpersonal barriers limiting anti-racist growth, and calls for solidarity.
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