Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd

Examining the Context and Content of Organizational Solidarity Statements on Black Americans' Expectations of Identity Safety

Despite the increasing use of organizational solidarity statements following instances of social injustice, little-to-no research has examined whether these statements signal inclusion for minoritized groups. The present work investigates how different types of solidarity statements affect Black Americans' sense of identity safety and assesses mechanisms underlying their responses. Across three online experiments, Black Americans recruited from Prolific Academic (N = 1,668) saw solidarity statements from a fictional organization that were either written in response to a race-related event at the societal level (e.g., George Floyd's murder; Studies 1-2) or an instance of racism occurring at the organizational level (Study 3). The statements were manipulated on three dimensions: acknowledgment of systemic racism, acknowledgment of organizational racism, and inclusion of concrete actions to address racism (Study 2). Findings showed that statements which acknowledged systemic racism or included actions to address racism were more likely to increase identity safety, whereas statements acknowledging racist organizational practices were relatively less effective at promoting identity safety. Feelings of identity safety emerged via decreased perceptions that the organization was engaging in performative allyship and/or increased perceptions of procedural fairness. Collectively, findings elucidate features of organizational solidarity statements that are more (versus less) effective for promoting identity safety among Black Americans.

Race and gender biases persist in public perceptions of scientists' credibility

This study examines how race and gender stereotypes affect scientists' ability to communicate with diverse US public audiences. Through a unique collaboration between researchers and filmmakers, we conducted an online survey experiment with a nationally representative U.S. quota sample, including an oversample of Black respondents (N = 1637). We found that Black female scientists face challenges in being perceived as warm and competent compared to their peers. Our findings revealed significant intersectional biases: Black female scientists received the lowest ratings in both warmth and competence, with ratings dropping further when introducing a story about a White patient. Black male scientists received consistently high ratings across experimental conditions, particularly showing elevated warmth scores when discussing a Black protagonist with sickle cell anemia. They also maintained high competence ratings whether working with Black or White protagonists. This pattern suggests that while Black scientists generally faced discrimination, Black men's gender afforded them certain privileges that were not extended to Black women in scientific fields. Our findings highlight persistent, intersectional biases and emphasize the need for comprehensive approaches to diversity and inclusion in scientific communication, which includes addressing the prejudices faced by female scientists and scientists of color.

From Bystander-to-Upstander: A Novel Intervention Framework to Address Microaggressions in a Pediatric Academic Medical Center

Microaggressions undermine health professionals' performance in patient care, research, and education. This study aimed to develop and evaluate an intervention addressing microaggressions in healthcare settings by empowering bystanders to act as upstanders across an academic medical center (AMC). This was achieved through an educational intervention that included a novel framework, didactics, video demonstrations, and practice with realistic scenarios. Methods Participants were faculty, trainees, education experts, clinical and administrative staff from a large, urban pediatric AMC. Participants were recruited from 3 training sessions, and taught the "Be Aware" and "ACT" framework, a novel tool for bystanders to use when witnessing microaggressions. Pre-training, retrospective pre-post, and 10-week follow-up surveys evaluated changes in awareness, confidence, and intervention rates. Quantitative analyses were conducted using generalized linear mixed effects models across the 3 surveys to assess participants' changes in confidence. Qualitative analysis used inductive content analysis. Results Among the 205 attendees, 134 (65.4%) completed the pre-training survey. The study cohort (n=108) included those who completed the pre-training survey with either the retrospective pre-post (n=24), 10-week follow-up (n=26), or both (n=58). Participants reported increased confidence in intervening during microaggressions, with confidence rising from 7.5% pre-training to 24.2% at 10-week follow-up (p=0.004). Qualitative analysis revealed a shift from passive response to active intervention, with participants applying the "Be Aware" and "ACT" framework during actual incidents. Conclusions The "Be Aware" and "ACT" framework increased and sustained awareness and confidence in addressing microaggressions. This AMC-wide intervention successfully equipped participants to move from passive bystanders to active upstanders.

Workplace discrimination and harassment among Alberta postgraduate medical trainees: a cross-sectional survey

BACKGROUND

Addressing a lack of diversity in the physician workforce is a priority in the Canadian healthcare system. Data describing demographics of residents and their experiences of discrimination, harassment, and racism at work are incomplete. The objective of this work was to describe the demographics and perceptions of workplace discrimination and harassment for postgraduate medical trainees in Alberta.

METHODS

A cross-sectional survey based on the Chronic Workplace Discrimination and Harassment Scale was administered to all resident physicians in Alberta by e-mail invitation from the postgraduate medical education offices at the Universities of Alberta and Calgary, their residency training program directors, and the Professional Association of Residents of Alberta. Total score (median, interquartile range [IQR]) was compared by gender, racial, and intersecting gender and racial identities, with higher scores suggesting more frequent experiences of workplace discrimination and harassment (range 0 to 32). We performed thematic content analysis of open text responses.

RESULTS

There were 195 complete surveys returned from 1,752 Alberta residents (11.2% response rate), including 120 cisgender women (61.5%), 104 white participants (53.3%) and 74 white cisgender women (37.9%). The overall median score on the Chronic Workplace Discrimination and Harassment scale was 9 (IQR 5-14): cisgender women and gender diverse participants reported more frequent harassment, mistreatment, or discrimination than cisgender men (median 10 [IQR 6-15] versus 8 [4-13.5], p = 0.049). There was no difference in the frequency of reported discrimination between BIPOC and white respondents (median 9 [IQR 5-14.5] versus 9.5 [IQR 6-14], p = 0.72) or participants with intersecting race and gender identities (p = 0.26). Over 44% of BIPOC residents had been the target of a racial slur or joke from an attending physician or colleague in the past year and nearly 45% of all participants had witnessed an attending physician or colleague using a racial slur in the past year. Open text responses provided examples of mistreatment, harassment, discrimination, and racism from participants.

INTERPRETATION

These results demonstrate an unacceptable prevalence of harassment and racism witnessed or experienced at work by Alberta residents. Urgent action to identify, prevent, and remediate racism in the healthcare system must be a priority of medical schools and regulatory bodies.

How Might we Build an Equitable Future? Design Justice, a Counternarrative to Dominant Approaches in Medical Education

PHENOMENON

Marginalized individuals in medicine face many structural inequities which can have enduring consequences on their progress. Therefore, inequity must be addressed by dismantling underlying unjust policies, environments, and curricula. However, once these injustices have been taken apart, how do we build more just systems from the rubble? Many current strategies to address this question have foundational values of urgency, solutionism, and top-down leadership.

APPROACH

This paper explores a counternarrative: Design Justice. As a set of guiding principles, Design Justice centers the experiences and perspectives of marginalized individuals and communities. These principles include mutual accountability and transparency, co-ownership, and community-led outcomes, and honoring local, traditional, Indigenous knowledge.

FINDINGS

Rooted in critical scholarship and critical design, Design Justice recognizes the interconnectedness of various forms of marginalization and works to critically examine power dynamics that exist in every design process. These co-created principles act as practical guardrails, directing progress toward justice.

INSIGHTS

This paper begins with an overview of Design Justice's history in critical scholarship and critical design, providing foundational background knowledge for medical educators, scholars, and leaders in key concepts of justice and design. We explore how the Design Justice principles were developed and have been applied across sectors, highlighting its applications, including education applications. Finally, we raise critical questions about medical education prompted by Design Justice.

Equity, diversity, and…exclusion? A national mixed methods study of "belonging" in Canadian undergraduate medical education

Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging.

A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data

BACKGROUND

Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design.

METHODS

We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism.

RESULTS

Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism.

CONCLUSIONS

Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.

The contribution of undergraduate medical education dress codes to systemic discrimination: A critical policy analysis

PURPOSE

Critical review of institutional policies is necessary to identify and eliminate structural discrimination in medical schools. Dress code policies are well known to facilitate discrimination in other settings.

METHODS

In this critical policy analysis, the authors used qualitative inquiry guided by feminist critical policy analysis (FCPA) and critical race feminism (CRF) frameworks to understand how Canadian undergraduate medical school dress code policies may contribute to discrimination and a hostile culture for marginalised groups. Dress code policies were obtained from 14 of 17 Canadian medical schools in September 2021. Deductive content analysis of dress codes was performed independently and in parallel by all four members of a racially diverse study team using Edwards and Marshalls' established framework for applying FCPA and CRF to dress code policy statements. Inductive content analysis was used to classify statements that fell outside this framework. Using a historical and contemporary legal understanding of how dress code policies have been used to discriminate against marginalised groups, the authors analysed how recommendations or restrictions may contribute to discrimination of marginalised medical students.

RESULTS

Fourteen dress code policies were analysed. Overall, there were five feminine-coded restrictions for every one masculine-coded restriction (n = 77/213 and n = 16/213, respectively). Some policies prohibited feminine-coded items (e.g. perfumes and bracelets) while specifically allowing masculine-coded items (e.g. cologne and watches). A discourse of 'professionalism' based on patient preferences prioritised Eurocentric patriarchal norms for appearance, potentially penalising racially and culturally diverse students. Most policies did not include a policy for appeals or accommodations.

CONCLUSION

Canadian undergraduate medical school dress code policies overregulate women and gender, racially and culturally diverse students by explicitly and implicitly enforcing white patriarchal social norms. Administrators should apply best practices to these policies to avoid discrimination and a hostile culture to marginalised groups.

The impact of social unrest due to systemic racism on underrepresented post-doctoral fellows and early-career faculty

Introduction

Social unrest tied to racism negatively impacted half of NIH-funded extramural researchers underrepresented (UR) in science. UR early-career scientists encounter more challenges in their research careers, but the impact of social unrest due to systemic racism in this group is unclear. We used mixed methods to describe the impact of social unrest due to systemic racism on mentoring relationships, research, and psychological well-being in UR post-doctoral fellows and early-career faculty.

Methods

This is a cross-sectional analysis of data collected in September 2021-January 2022 from 144 UR early-career researchers from 25 academic medical centers in the Building Up Trial. The primary outcomes were agreement on five-point Likert scales with social unrest impact statements (e.g., "I experienced psychological distress due to events of social unrest regarding systemic racism"). Thematic analysis was conducted on responses to one open-ended question assessing how social unrest regarding systemic racism affected participants.

Results

Most participants were female (80%), non-Hispanic Black (35%), or Hispanic (40%). Over half of participants (57%) experienced psychological distress as a result of social unrest due to systemic racism. Participants described direct and indirect discrimination and isolation from other persons of color at their institutions. Twice as many participants felt their mentoring relationships were positively (21%) versus negatively (11%) impacted by social unrest due to systemic racism.

Conclusions

Experiences with racial bias and discrimination impact the career and well-being of UR early-career researchers. Mentoring relationships and institutional support play an important role in buffering the negative impact of racial injustice for this population.

Doing the Work-or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers

While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.