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Wilson EJ, Primgaard AR, Hambrick EP, Marszalek JM, Berkley-Patton J, Nilsson JE, Bennett KK. Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors. J Behav Med 2024; 47:515-530. [PMID: 38281260 PMCID: PMC11031310 DOI: 10.1007/s10865-023-00464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/08/2023] [Indexed: 01/30/2024]
Abstract
Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (β = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (β = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (β = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (β = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (β = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (β = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.
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Affiliation(s)
- Elizabeth J Wilson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA.
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Anahi R Primgaard
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Erin P Hambrick
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacob M Marszalek
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Johanna E Nilsson
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kymberley K Bennett
- Department of Psychology and Counseling, University of Missouri-Kansas City, Kansas City, MO, USA
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Skan O, Tregidgo L, Tizzard J, Westlake I, Joji N. Examining medical students' experience of gender-based discrimination and sexual harassment from clinical teachers at a UK medical school. MEDICAL TEACHER 2024:1-9. [PMID: 38564885 DOI: 10.1080/0142159x.2024.2331034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF THE ARTICLE To quantify the prevalence and characterise the nature of gender-based discrimination (GBD) and sexual harassment (SH) arising from clinical teachers towards medical students at one UK medical school. MATERIALS AND METHODS A mixed quantitative and qualitative survey of medical students. Chi-squared analysis and logistic regression was performed on quantitative data, while an inductive thematic analysis of qualitative data was undertaken. These findings were compared to look for common patterns. RESULTS Females were significantly more likely to report experiencing both GBD (χ2 = 38.61, p < 0.0001) and SH (χ2 = 19.53, p < 0.0001) than males (OR = 10.45 (CI 4.84 - 22.56, p < 0.0001)). These behaviours were more likely to be reported in specific surgical placements than medical placements (χ2 = 15.06, p < 0.001 and χ2 = 5.90, p < 0.05). Perpetrators were more commonly male, and more commonly consultants. Exposure to GBD or SH was significantly more likely to affect the choice of specialty in females compared to males (χ2 = 11.17, p < 0.001). Students noted a casual use of sexist language, inappropriate sexual advances, and gender-based microaggressions which create a pervasive discrepancy in educational opportunities between genders. Participants reported that concerns regarding anonymity, questioning the severity of the incident, and an ingrained medical hierarchy prevented students reporting these incidents. CONCLUSIONS The rate of GBD and SH from clinical teachers to medical students remains high, affecting female students more than male students. This study highlights key areas that must be improved to achieve a more equitable teaching experience in UK medical schools. Developing robust reporting and support systems is an important step in eradicating these behaviours.
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Affiliation(s)
- Oliver Skan
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Laura Tregidgo
- Medical Sciences Division, University of Oxford, United Kingdom
| | - James Tizzard
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Isabel Westlake
- Medical Sciences Division, University of Oxford, United Kingdom
| | - Nikita Joji
- Royal Free London NHS Trust, London, United Kingdom
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Faller V, Gerken AT, Vestal HS, Beckmann DL, Canelos VE, Emmerich A, Fernandez-Robles C, Quijije N, Rodriguez-Villa AM, Stoklosa J, Trinh NHT. Bias at the Bedside: a Roleplay-Based Workshop for Responding to Biased Comments in the Teaching Hospital. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:173-177. [PMID: 36973634 PMCID: PMC10042580 DOI: 10.1007/s40596-023-01761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
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Binda DD, Kraus A, Gariépy-Assal L, Tang B, Wade CG, Olveczky DD, Molina RL. Anti-racism curricula in undergraduate medical education: A scoping review. MEDICAL TEACHER 2024:1-11. [PMID: 38431914 DOI: 10.1080/0142159x.2024.2322136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Medical educators have increasingly focused on the systemic effects of racism on health inequities in the United States (U.S.) and globally. There is a call for educators to teach students how to actively promote an anti-racist culture in healthcare. This scoping review assesses the existing undergraduate medical education (UME) literature of anti-racism curricula, implementation, and assessment. METHODS The Ovid, Embase, ERIC, Web of Science, and MedEdPORTAL databases were queried on 7 April 2023. Keywords included anti-racism, medical education, and assessment. Inclusion criteria consisted of any UME anti-racism publication. Non-English articles with no UME anti-racism curriculum were excluded. Two independent reviewers screened the abstracts, followed by full-text appraisal. Data was extracted using a predetermined framework based on Kirkpatrick's educational outcomes model, Miller's pyramid for assessing clinical competence, and Sotto-Santiago's theoretical framework for anti-racism curricula. Study characteristics and anti-racism curriculum components (instructional design, assessment, outcomes) were collected and synthesized. RESULTS In total, 1064 articles were screened. Of these, 20 met the inclusion criteria, with 90% (n = 18) published in the past five years. Learners ranged from first-year to fourth-year medical students. Study designs included pre- and post-test evaluations (n = 10; 50%), post-test evaluations only (n = 7; 35%), and qualitative assessments (n = 3; 15%). Educational interventions included lectures (n = 10, 50%), multimedia (n = 6, 30%), small-group case discussions (n = 15, 75%), large-group discussions (n = 5, 25%), and reflections (n = 5, 25%). Evaluation tools for these curricula included surveys (n = 18; 90%), focus groups (n = 4; 20%), and direct observations (n = 1; 5%). CONCLUSIONS Our scoping review highlights the growing attention to anti-racism in UME curricula. We identified a gap in published assessments of behavior change in applying knowledge and skills to anti-racist action in UME training. We also provide considerations for developing UME anti-racism curricula. These include explicitly naming and defining anti-racism as well as incorporating longitudinal learning opportunities and assessments.
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Affiliation(s)
- Dhanesh D Binda
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alexandria Kraus
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Laurence Gariépy-Assal
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - Brandon Tang
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Carrie G Wade
- Countway Library of Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniele D Olveczky
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Division of Global and Community Health, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Betancourt RM, Baluchi D, Dortche K, Campbell KM, Rodríguez JE. Minority Tax on Medical Students: A Review of the Literature and Mitigation Recommendations. Fam Med 2024; 56:169-175. [PMID: 38467005 DOI: 10.22454/fammed.2024.268466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES Accreditation standards for MD- and DO-granting institutions require medical schools to recruit a diverse student body and educate students about diverse groups of patients. The minority tax is a summary of responsibilities assigned to racial and ethnic underrepresented faculty to achieve diversity, equity, and inclusion in medical institutions in addition to their typical academic workload. This article provides a narrative review of medical students' experiences of the minority tax and recommendations on how medical educators can support an equitable learning environment by eliminating the minority tax. METHODS We searched the PubMed, Web of Science, and Scopus databases, Google Scholar, and medical society websites, blogs, and fora for terms, including minority tax, medical students, and undergraduate medical education. We included publications if they discussed the underrepresented in medicine medical students' experiences of the minority tax. RESULTS Our search yielded six peer-reviewed original research articles and six publications of commentaries, opinion pieces, or news pieces. Students who were underrepresented in medicine reported spending more hours on diversity efforts compared with students who were not underrepresented; moreover, students reported that they had to sacrifice academic excellence in order to fulfill these additional diversity duties. CONCLUSIONS The minority tax among medical students constitutes an unequitable and unjust barrier to career advancement, and it likely represents an early cause of attrition in the pipeline of underrepresented in medicine academic faculty. Medical educators can enact specific recommendations to eliminate or mitigate the minority tax experience for medical students.
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Affiliation(s)
- Renée M Betancourt
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Donna Baluchi
- Spencer S. Eccles Health Sciences Library, University of Utah, Salt Lake City, UT
| | - Kristina Dortche
- Urology Residency Training Program, Cleveland Clinic, Cleveland, OH
| | - Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - José E Rodríguez
- University of Utah Health Equity, Diversity and Inclusion, Salt Lake City, UT
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Dawson D, Bell SB, Hollman N, Lemens T, Obiozor C, Safo D, Manning T. Assaults and Microaggressions Against Psychiatric Residents: Findings from a US Survey. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01933-7. [PMID: 38291313 DOI: 10.1007/s40596-024-01933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Psychiatric physicians may experience higher rates of assault than those in other fields. For many reasons, residents may be especially vulnerable. This study updates rates of assaults among US psychiatry residents as well as the reporting rates and emotional effects of these incidents. Little data exists to examine rates of microaggressions against psychiatry residents. METHODS A cross-sectional online survey was distributed through a national residency database via a snowball-sampling approach between June and September of 2021. The questionnaire asked about experiences of verbal, physical, and sexual assaults, as well as microaggressions and their impact. Descriptive analyses of the obtained data were conducted. RESULTS The survey was completed by 275 psychiatry residents from 29 states (63.6% women). At least one form of assault was experienced by 78.9% of participants with 74.5% experiencing verbal, 22.2% experiencing physical, and 6.2% experiencing sexual assault. At least one type of microaggression was experienced by 86.9% of trainees. Elevations in PTSD scores were seen in residents who identified as women and non-White and those physically injured or sexually assaulted. While 92.7% of residents stated their program provided training about assault, 25% of residents indicated they had no training on recognizing and responding to microaggressions. CONCLUSIONS Psychiatric residents experience widespread assault and microaggressions in the clinical setting but often do not report them. Due to the ubiquitous nature of these events, programs should provide training about early recognition and de-escalation techniques for agitation, responding effectively to microaggressions, and the importance of reporting events.
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Affiliation(s)
- Drew Dawson
- Oklahoma City Indian Clinic, Oklahoma City, OK, USA
| | - Sarah Beth Bell
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Nicholas Hollman
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Tara Lemens
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | | | - Danielle Safo
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA
| | - Tessa Manning
- University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
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Bromberg GK, Berwick JR, Horick NK, Burnett-Bowie SAM. Experiences of bias in a multidisciplinary hospital medicine group. J Am Assoc Nurse Pract 2024:01741002-990000000-00194. [PMID: 38214679 DOI: 10.1097/jxx.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
ABSTRACT Clinicians report experiencing bias at work. Although previous studies have characterized these experiences among trainees and clinical faculty, ours is the first to describe experiences of bias within a multidisciplinary hospital medicine group. In our study, 82.5% of surveyed nurse practitioners (NPs), physician assistants (PAs), and physicians reported experiencing gender, racial, or other forms of bias in the workplace. In addition to women reporting higher rates of gender bias and Asian/Black/Latinx/multiracial/other race respondents reporting higher rates of racial bias, half of participants reported experiencing other forms of bias related to gender expression, perceived sexual orientation, body habitus, age, accent, country of origin, or perceived socioeconomic status. Respondents infrequently addressed bias with the person expressing it. Our study expands on the existing literature about experiences of bias by studying a large, multidisciplinary, academic hospital medicine group. With the increasing inclusion of NPs and PAs in hospital medicine, understanding their experiences will enable development of tailored interventions to reduce harm from experiences of bias.
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Affiliation(s)
- Gabrielle Kis Bromberg
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jessica R Berwick
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Nora K Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Sherri-Ann M Burnett-Bowie
- Harvard Medical School, Boston, Massachusetts
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Jowell AR, James AK, Jasrasaria R, Kelly MS, Matthiesen MI, Vyas DA, Burnett-Bowie SAM, Zeidman JA. DARE Training: Teaching Educators How to Revise Internal Medicine Residency Lectures by Using an Anti-racism Framework. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11351. [PMID: 37941996 PMCID: PMC10627787 DOI: 10.15766/mep_2374-8265.11351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/23/2023] [Indexed: 11/10/2023]
Abstract
Introduction Systemic inequities and provider-held biases reinforce racism and further disparities in graduate medical education. We developed the Department of Medicine Anti-Racism and Equity Educational Initiative (DARE) to improve internal medicine residency conferences. We trained faculty and residents to serve as coaches to support other faculty in delivering lectures. The training leveraged a best-practices checklist to revise existing lectures. Methods We recruited internal medicine faculty and residents to serve as DARE coaches, who supported educators in improving lectures' anti-racism content. During the training, coaches watched a videotaped didactic presentation that we created about health equity and anti-racism frameworks. DARE coaches then participated in a workshop where they engaged in case-based learning and small-group discussion to apply the DARE best-practices checklist to sample lecture slides. To assess training effectiveness, coaches completed pre- and posttraining assessments in which they edited different sample lecture slides. Our training took 1 hour to complete. Results Thirty-four individuals completed DARE training. Following the training, the sample slides were significantly improved with respect to diversity of graphics (p < .001), discussion of research participant demographics (p < .001), and discussion of the impact of racism/bias on health disparities (p = .03). After DARE training, 23 of 24 participants (96%) endorsed feeling more prepared to bring an anti-racist framework to lectures and to support colleagues in doing the same. Discussion Training residents and faculty to use DARE principles in delivering internal medicine lectures is an innovative and effective way to integrate anti-racism into internal medicine residency conferences.
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Affiliation(s)
- Amanda R. Jowell
- First-Year Resident, Department of Medicine, Massachusetts General Hospital
| | - Aisha K. James
- Primary Care Physician and Director for Racial Justice, Department of Medicine, and Primary Care Physician and Associate Director for the Diversity, Equity and Inclusion Committee, Department of Pediatrics, Massachusetts General Hospital for Children; Instructor in Medicine, Harvard Medical School
| | - Rashmi Jasrasaria
- Primary Care Physician, Department of Medicine, and Associate Director, Center for Immigrant Health, Massachusetts General Hospital; Instructor in Medicine, Harvard Medical School
| | - Michael S. Kelly
- Pulmonary and Critical Care Fellow, Department of Medicine, Massachusetts General Hospital and Beth Israel Deaconess Medical Center
| | - Madeleine I. Matthiesen
- Hospitalist, Departments of Medicine and Pediatrics, Core Educator Faculty, Department of Medicine, Associate Program Director, Internal Medicine and Pediatrics Residency Program, Massachusetts General Hospital for Children; Instructor in Medicine, Harvard Medical School
| | - Darshali A. Vyas
- Pulmonary and Critical Care Fellow, Department of Medicine, Massachusetts General Hospital and Beth Israel Deaconess Medical Center
| | - Sherri-Ann M. Burnett-Bowie
- Endocrinologist, Department of Medicine, Massachusetts General Hospital; Associate Professor of Medicine, Harvard Medical School; Associate Director, Massachusetts General Center for Diversity and Inclusion, Massachusetts General Hospital; and Chair, Diversity and Inclusion Board, Department of Medicine, Massachusetts General Hospital
- Co-senior author
| | - Jessica A. Zeidman
- Primary Care Physician and Primary Care Program Director, Department of Medicine, Massachusetts General Hospital; Instructor in Medicine, Harvard Medical School
- Co-senior author
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Barber Doucet H, Wilson T, Vrablik L, Wing R. Implicit Bias and Patient Care: Mitigating Bias, Preventing Harm. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11343. [PMID: 37731596 PMCID: PMC10507144 DOI: 10.15766/mep_2374-8265.11343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/08/2023] [Indexed: 09/22/2023]
Abstract
Introduction Simulation is a valuable and novel tool in the expanding approach to racism and bias education for medical practitioners. We present a simulation case focused on identifying and addressing the implicit bias of a consultant to teach bias mitigation skills and limit harm to patients and families. Methods Learners were presented with a case of a classic toddler's fracture in an African American child. The learners interacted with an orthopedic resident who insisted on child welfare involvement, with nonspecific and increasingly biased concerns about the child/family. The learners were expected to identify that this case was not concerning for nonaccidental trauma and that the orthopedic resident was demonstrating bias. They were expected to communicate with both the resident and the parent effectively to defuse the situation and prevent harm from reaching the family. A debrief and an anonymous survey followed the case. Results Seventy-five learners participated, including pediatric and emergency medicine residents, fellows, attendings, and medical students. After the case, the majority of learners expressed confidence that they could recognize racial bias in the care of a patient (90%), ensure patient care was not influenced by racial bias (88%), and utilize a tool to frame a concern about bias (79%). Discussion Participants felt that this simulation was relevant and effective and overall left the experience feeling confident in their abilities to identify and manage racially biased patient care. This anti-racist simulation offers an important skill-building opportunity that has been well received by learners.
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Affiliation(s)
- Hannah Barber Doucet
- Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston University School of Medicine
| | - Taneisha Wilson
- Assistant Professor, Department of Emergency Medicine, Warren Alpert Medical School of Brown University
| | - Lauren Vrablik
- Third-Year Fellow, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Warren Alpert Medical School of Brown University
| | - Robyn Wing
- Associate Professor, Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital, and Director of Pediatric Simulation, Lifespan Medical Simulation Center
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Stephens KC, Redman T, Williams R, Bandstra B, Shah R. Considering Culture and Conflict: A Novel Approach to Active Bystander Intervention. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11338. [PMID: 37649621 PMCID: PMC10462770 DOI: 10.15766/mep_2374-8265.11338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/21/2023] [Indexed: 09/01/2023]
Abstract
Introduction Workplace microaggressions are prevalent in clinical settings and contribute to poorer mental health outcomes, as well as to higher rates of burnout for physicians and students experiencing them. While bystander workshops customarily provide guidance on direct interventions to a general audience, the literature does not yet address workshops in an academic setting that consider the individual's motivations and behavior patterns. We implemented a psychologically informed approach to microaggression training to increase participants' understanding and willingness to undergo behavioral change. Methods We created a survey that included 10 distinct scenarios of discrimination in the clinical setting. Participants' willingness to intervene was assessed on a Likert scale prior to, then following, a 1-hour active bystander intervention workshop conducted virtually. The workshop outlined the role of culture and conflict management style in willingness to intervene. Four modes of intervention were outlined, including direct and indirect methods. Results A total of 78 medical students, graduate students, residents, and faculty members participated in the workshop. Of those, we compared 68 individuals' pre- and postworkshop responses to our questionnaire. We then focused on the 54 participants with no previous training in psychiatry or psychology. Utilizing a Wilcoxon signed rank test, we compared the average pre/post scores of willingness to intervene and found scores to have improved following workshop attendance (Z = -6.339, p < .001). Discussion Our findings suggest that a psychiatrically informed and culturally sensitive approach to active bystander intervention workshops may promote upstanding more effectively in academic medicine.
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Affiliation(s)
- Kathryn C. Stephens
- Fourth-Year Resident, Department of Psychiatry and Behavioral Sciences, Stanford Hospitals and Clinics
| | - Tené Redman
- Fourth-Year Resident, Department of Psychiatry and Behavioral Sciences, Stanford Hospitals and Clinics
| | - Reneé Williams
- Professor of Medicine, Department of Medicine, NYU Grossman School of Medicine
| | - Belinda Bandstra
- Health Sciences Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Ripal Shah
- Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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Morrison N, Zaman T, Webster G, Sorinola O, Blackburn C. 'Where are you really from?': a qualitative study of racial microaggressions and the impact on medical students in the UK. BMJ Open 2023; 13:e069009. [PMID: 37147091 PMCID: PMC10163503 DOI: 10.1136/bmjopen-2022-069009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVE To explore graduate-entry medical students' experiences of racial microaggressions, the impact of these on learning, performance and attainment, and their views on how these can be reduced. DESIGN Qualitative study using semistructured focus groups and group interviews. SETTING UK. PARTICIPANTS 20 graduate-entry medical students were recruited using volunteer and snowball sampling; all students self-identified as being from racially minoritised (RM) backgrounds. RESULTS Participants reported experiencing numerous types of racial microaggressions during their time at medical school. Students' accounts highlighted how these impacted directly and indirectly on their learning, performance and well-being. Students frequently reported feeling uncomfortable and out of place in teaching sessions and clinical placements. Students also reported feeling invisible and ignored in placements and not being offered the same learning opportunities as their white counterparts. This led to lack of access to learning experiences or disengagement from learning. Many participants described how being from an RM background was associated with feelings of apprehension and having their 'guards up', particularly at the start of new clinical placements. This was perceived to be an additional burden that was not experienced by their white counterparts. Students suggested that future interventions should focus on institutional changes to diversify student and staff populations; shifting the culture to build and maintain inclusive environments; encouraging open, transparent conversations around racism and promptly managing any student-reported racial experiences. CONCLUSION RM students in this study reported that their medical school experiences were regularly affected by racial microaggressions. Students believed these microaggressions impeded their learning, performance and well-being. It is imperative that institutions increase their awareness of the difficulties faced by RM students and provide appropriate support in challenging times. Fostering inclusion as well as embedding antiracist pedagogy into medical curricula is likely to be beneficial.
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Affiliation(s)
- Nariell Morrison
- Department of Education, University of Oxford, Oxford, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tabbasum Zaman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Georgia Webster
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olanrewaju Sorinola
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Adynski GI, Bravo LG, Emmanuel CJ, Ledford A, Ikharo E, Zaragoza S, Harris LK, Rodgers S, Woods-Giscombe C. Barriers and facilitators to recruitment and retention of underrepresented racial and ethnic minoritized students to PhD programs in nursing: A qualitative descriptive study. Nurs Outlook 2023; 71:101962. [PMID: 37003089 DOI: 10.1016/j.outlook.2023.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND There is a global shortage of Doctor of Philosophy (PhD)-trained nurses, which is amplified among underrepresented racial and ethnic groups who are minoritized. PURPOSE This study explores barriers and facilitators to recruiting under-represented racial-ethnic group who are minoritized (UREM) PhD nursing students, defined as African American, Black, American Indian, Alaskan Native, or Hispanic/Latinx. METHODS Using a qualitative descriptive design, interviews of 23 UREM PhD nursing students were analyzed with conventional content analysis. DISCUSSION Barriers to recruitment and retention included identifying students interested in a PhD, organizational culture of programs, student mental health, and lack of social support. Facilitators for recruitment and retention included less discrimination and microaggressions experienced by students, faculty from groups who are minoritized representation, and strong family support. These findings had implications for recruitment and retention and PhD programs in nursing can focus on the above key areas to better recuit and retain UREM students. CONCLUSION Allocating funding to culturally tailored mental health resources, student scholarships, and increasing UREM members of faculty within PhD programs.
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Affiliation(s)
| | - Lilian G Bravo
- University of California, School of Nursing, Los Angeles, CA
| | | | - Alasia Ledford
- University of North Carolina, School of Nursing, Chapel Hill, NC
| | - Ebahi Ikharo
- University of North Carolina, School of Nursing, Chapel Hill, NC
| | - Sandra Zaragoza
- University of North Carolina, School of Nursing, Chapel Hill, NC
| | - Latesha K Harris
- University of North Carolina, School of Nursing, Chapel Hill, NC
| | - Shielda Rodgers
- University of North Carolina, School of Nursing, Chapel Hill, NC
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Active Bystander Training: Using Standardized Patient Methodology to Teach Residents to Navigate Microaggressions in Patient Encounters. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11298. [PMID: 36760336 PMCID: PMC9886691 DOI: 10.15766/mep_2374-8265.11298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
Introduction Studies show that physicians and medical trainees who identify as underrepresented in medicine or as women experience higher rates of microaggressions during patient encounters. We designed, implemented, and evaluated an active bystander training workshop focused on mitigating microaggressions using standardized patient (SP) methodology. Methods Internal medicine faculty members and chief residents led the workshop. Participants included 31 PGY 1 categorical and preliminary internal medicine residents. They participated in three case simulations with SPs involving microaggressions from patients toward a member of the health care team. Prior to the case simulations, a brief presentation outlined examples of microaggressions and reviewed the behavioral response framework WAKE (work with who you are, ask questions/make direct statements, involve key people, and employ distraction techniques). After each encounter, residents debriefed with an internal medicine faculty member and discussed questions related to each scenario. Results All 31 residents participated in the workshop and, before and after the activity, completed a survey that asked them to rank their agreement with statements via a Likert scale. Participants reported statistically significant improvement in recognizing microaggressions (12% reported increase, p = .002), the ability to respond to patients who exhibit microaggressions (23% reported increase, p < .001), and the ability to debrief with team members (20% reported increase, p < .001). Discussion SP simulations can be an effective teaching modality for microaggression response strategies during patient encounters. Additional studies are needed to further characterize the workshop's effect on other medical workforce trainees and retention of skills over time.
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Baker L, Logan LD, Brooks K, Sikora A. Responding to racism, discrimination, and microaggressions: A student-designed case-based learning program. Am J Health Syst Pharm 2023; 80:98-101. [PMID: 36269036 DOI: 10.1093/ajhp/zxac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Leanna Baker
- Division of Experience Programs University of Georgia College of Pharmacy Athens, GA, USA
| | - Linda D Logan
- Division of Experience Programs University of Georgia College of Pharmacy Athens, GA, USA
| | - Kay Brooks
- Division of Experience Programs University of Georgia College of Pharmacy Athens, GA, USA
| | - Andrea Sikora
- Department of Clinical and Administrative Pharmacy University of Georgia College of Pharmacy Augusta, GA.,Department of Pharmacy Augusta University Medical Center Augusta, GA, USA
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Microaggressions and Implicit Bias in Surgical Training: An Undocumented but Pervasive Phenomenon. Ann Surg 2023; 277:e192-e196. [PMID: 33843793 DOI: 10.1097/sla.0000000000004917] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the prevalence, nature, and source of microaggressions experienced by surgical residents during training. SUMMARY AND BACKGROUND DATA The role of microaggressions in contributing to workplace culture, individual performance, and professional satisfaction has become an increasingly studied topic across various fields. Little is known about the prevalence and impact of microaggressions during surgical training. METHODS A 46-item survey distributed to current surgical residents in training programs across the United States via the Association of Program Directors in Surgery listserv and social media platforms between January and May 2020. Survey questions explored the frequency and extent of events of experiencing, witnessing, and responding to microaggressions in the workplace. The primary outcome was the occurrence of microaggressions experienced by surgical residents. Secondary outcomes included the nature, impact, and responses to these events. RESULTS A total of 1624 responses were collected, with an equal distribution by self-identified gender (female, n = 815; male, n = 809). The majority of trainees considered themselves heterosexual (n = 1490, 91.7%) and White (n = 1131, 69.6%). A majority (72.2%, n = 1173) of respondents reported experiencing microaggressions, most commonly from patients (64.1%), followed by staff (57.5%), faculty (45.3%), and co-residents (38.8%). Only a small proportion (n = 109, 7.0%) of residents reported these events to graduate medical education office/program director. Nearly one third (30.8%) of residents said they experienced retaliation due to reporting of micro-aggressions. CONCLUSIONS Based on this large, national survey of general surgery and surgical subspecialty trainees, microaggressions appear to be pervasive in surgical training. Microaggressions are rarely reported to program leadership, and when reported, can result in retaliation.
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What Happened and Why: Responding to Racism, Discrimination, and Microaggressions in the Clinical Learning Environment. MEDEDPORTAL 2022; 18:11280. [PMID: 36381136 PMCID: PMC9622434 DOI: 10.15766/mep_2374-8265.11280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Within clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM. METHODS Guided by generalized and targeted needs assessments, we created a case-based curriculum to practice communication responses to address RDM. The communication framework, a 6Ds approach, was developed through adaptation and expansion of established and previously learned communication upstander frameworks. Cases were collected through volunteer submission and revised to maintain anonymity. Faculty and senior medical students cofacilitated the small-group sessions. During the sessions, students reviewed the communication framework, explored their natural response strategies, and practiced all response strategies. RESULTS Of 196 workshop participants, 152 (78%) completed the evaluation surveys. Pre- and postsession survey cohort comparison demonstrated a significant increase in students' awareness of instances of RDM (from 34% to 46%), knowledge of communication strategies to mitigate RDM (presession M = 3.4, postsession M = 4.6, p < .01), and confidence to address RDM (presession M = 3.0, postsession M = 4.4, p < .01). DISCUSSION Students gained valuable communication skills from interactive sessions addressing RDM using empathy, reflection, and relatability. The workshop empowered students to feel prepared to enter professional teams and effectively mitigate harmful discourse.
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Wittkower LD, Bryan JL, Asghar-Ali AA. A Scoping Review of Recommendations and Training to Respond to Patient Microaggressions. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:627-639. [PMID: 34613599 DOI: 10.1007/s40596-021-01533-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Patient microaggressions affect practitioners in all fields of healthcare and especially psychiatry. In multiple studies, healthcare professionals reported high rates of patient microaggressions and discrimination. To date, this is the first scoping review of recommendations and trainings on patient microaggressions. METHOD A scoping review of articles indexed in PubMed, PsycINFO, Medline, ERIC, and MedEdPORTAL was conducted from July 2020 to August 2020 to identify recommendations and solutions for healthcare professionals on responding to patient microaggressions. RESULTS The review identified 27 studies that provide recommendations and trainings for healthcare professionals to address patient microaggressions. Twenty studies outlined recommendations for healthcare professionals and systems on how to respond to patient offenses. These 20 studies were grouped into establishing a supportive culture, addressing the microaggression, supporting the targets of microaggressions, discriminatory requests, and institutional responses. Six articles described trainings that equip providers with tools to address patient microaggressions, including the ERASE framework ("Expect/Recognize/Address/Support/Establish, Encourage"); Stop, Talk, and Roll; interrupting microaggressions; XYZ ("I felt X when Y because Z"); the ACTION model ("Ask/Come/Tell/Impact/Own/Next"); and the OWTFD tool ("Observe/Why/Think/Feel/Desire"). CONCLUSION Recommendations and trainings for the response to microaggressions are emerging, and results of trainings are encouraging. However, more work is needed to evaluate the effectiveness of these trainings in clinical settings and longitudinally.
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Affiliation(s)
| | - Jennifer L Bryan
- VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Ali A Asghar-Ali
- VA South Central Mental Illness Research, Education and Clinical Center (MIRECC), Michael E. DeBakey VA Medical Center, Houston, TX, USA
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McLaughlin JE, Morbitzer KA, Volkmar B, Harris SC, Williams CR, Wolcott MD, Jarstfer MB, White CY. Designing an Inclusive Learning Training Series for Pharmacy Educators. PHARMACY 2022; 10:pharmacy10050113. [PMID: 36136846 PMCID: PMC9498629 DOI: 10.3390/pharmacy10050113] [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: 07/23/2022] [Revised: 08/26/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
This article describes the design, implementation, and evaluation of five faculty development sessions focused on inclusive teaching strategies in pharmacy education. Inclusive strategies ensure that every student can clearly understand and engage in meaningful learning opportunities. Three sessions were implemented in fall 2020 and two in spring 2021. Sessions focused on experiential, didactic, and graduate education. A convergent parallel mixed methods evaluation was conducted using descriptive statistics and thematic analysis. Sessions were highly rated, and participants provided suggestions for curriculum improvement (e.g., creating resources, surveying students, and peer auditing syllabi for aspects of inclusiveness). Given the increasing emphasis on inclusion in pharmacy education, this work is timely for sharing strategies aimed at faculty development and teaching practices.
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Affiliation(s)
- Jacqueline E. McLaughlin
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
- Correspondence:
| | - Kathryn A. Morbitzer
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Bethany Volkmar
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Suzanne C. Harris
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Charlene R. Williams
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Michael D. Wolcott
- Workman School of Dental Medicine, High Point University, High Point, NC 27268, USA
| | - Michael B. Jarstfer
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Carla Y. White
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
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Fisher HN, Chatterjee P, Warren SB, Yialamas MA. Witnessed Microaggression Experiences of Internal Medicine Trainees: a Single-Site Survey. J Gen Intern Med 2022; 37:3208-3210. [PMID: 35319080 PMCID: PMC9485325 DOI: 10.1007/s11606-022-07415-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Herrick Nadine Fisher
- Brigham & Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Paula Chatterjee
- Perelman School of Medicine at the University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Sophia Bellin Warren
- Harvard Medical School, Boston, MA, USA
- Dana Farber Cancer Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Maria A Yialamas
- Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Smith PD, Evans CA, Fleming E, Mays KA, Rouse LE, Sinkford J. Establishing an antiracism framework for dental education through critical assessment of accreditation standards. J Dent Educ 2022; 86:1063-1074. [PMID: 36165256 DOI: 10.1002/jdd.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education. METHODS The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts. RESULTS Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service. CONCLUSIONS The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.
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Affiliation(s)
- Patrick D Smith
- Division of Prevention and Public Health Sciences, University of Illinois Chicago College of Dentistry, Chicago, Illinois, USA
| | - Caswell A Evans
- Division of Prevention and Public Health Sciences, University of Illinois Chicago College of Dentistry, Chicago, Illinois, USA
| | - Eleanor Fleming
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Keith A Mays
- University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
| | - Leo E Rouse
- Howard University College of Dentistry, Washington, District of Columbia, USA
| | - Jeanne Sinkford
- Howard University College of Dentistry, Washington, District of Columbia, USA
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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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Forrest LL, Geraghty JR. Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:781-785. [PMID: 35234719 DOI: 10.1097/acm.0000000000004644] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Trainees' value as effective leaders within academic medicine has been increasingly recognized. From their perspective as adult learners who enter medical education from diverse backgrounds, trainees offer significant value to the teaching, learning, and practice of medicine. As such, trainees have developed and led various successful initiatives throughout academic medicine. In this Invited Commentary, 2 medical students with national leadership roles provide their perspectives on how student-led initiatives and advocacy can help push academic medicine forward. The authors first provide an overview of the success of student-led initiatives throughout medical education as evidenced by the Trainee-Authored Letters to the Editor in this issue, highlighting the unique contributions and perspectives of trainees in the development and implementation of new initiatives or ways of thinking. Although trainees add value to many areas in academic medicine, here the authors highlight 4 current areas that align with Association of American Medical Colleges priorities: (1) public health emergencies including the COVID-19 pandemic; (2) equity, inclusion, and diversity; (3) wellness and resilience amongst trainees and health care providers; and (4) recent changes to the United States Medical Licensing Examination and the transition to residency. By sharing their experiences with student-led initiatives within each of these domains, the authors provide lessons learned and discuss successes and obstacles encountered along the way. Overall, there is a critical need for increased engagement of trainees in medical education. Empowering trainees now ensures the academic medicine leaders of tomorrow are prepared to face the challenges that await them.
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Affiliation(s)
- Lala L Forrest
- L.L. Forrest is a third-year medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Joseph R Geraghty
- J.R. Geraghty is a third-year medical student in the Medical Scientist Training Program (MSTP) at the University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-6828-4893
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Liu CZ, Wang E, Nguyen D, Sun MD, Jumreornvong O. The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:797-803. [PMID: 35703909 DOI: 10.1097/acm.0000000000004639] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has resulted in an alarming increase in hate incidents directed toward Asian Americans and Pacific Islanders (AAPIs), including verbal harassment and physical assault, spurring the nationwide #StopAsianHate movement. This rise in anti-Asian sentiment is occurring at a critical time of racial reckoning across the United States, galvanized by the Black Lives Matter movement, and of medical student calls for the implementation of antiracist medical curricula. AAPIs are stereotyped by the model minority myth, which posits that AAPIs are educated, hardworking, and therefore able to achieve high levels of success. This myth acts as a racial wedge between minorities and perpetuates harm that is pervasive throughout the field of medicine. Critically, the frequent aggregation of all AAPI subgroups as one monolithic community obfuscates socioeconomic and cultural differences across the AAPI diaspora while reinforcing the model minority myth. Here, the authors illustrate how the model minority myth and data aggregation have negatively affected the recruitment and advancement of diverse AAPI medical students, physicians, and faculty. Additionally, the authors discuss how data aggregation obscures health disparities across the AAPI diaspora and how the model minority myth influences the illness experiences of AAPI patients. Importantly, the authors outline specific actionable policies and reforms that medical schools can implement to combat anti-Asian sentiment and support the AAPI community.
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Affiliation(s)
- Clifford Z Liu
- C.Z. Liu is an MD-PhD candidate, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0003-1783-299X
| | - Eileen Wang
- E. Wang is a first-year resident, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Don Nguyen
- D. Nguyen is an MD-PhD candidate, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary D Sun
- M.D. Sun is an MD-MSCR candidate, Icahn School of Medicine at Mount Sinai, New York, New York, and an MA candidate, Harvard University, Cambridge, Massachusetts
| | - Oranicha Jumreornvong
- O. Jumreornvong is a fourth-year medical student, Icahn School of Medicine at Mount Sinai, New York, New York
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Crawford BA, Hillier A. Assessing the experience of dental students with an asynchronous online course about racism, cultural competence. J Dent Educ 2022; 86:1359-1368. [PMID: 35470902 DOI: 10.1002/jdd.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE University of Pennsylvania School of Dental Medicine and the University of Pennsylvania School of Social Policy and Practice (SP2) designed an asynchronous online course about racism and cultural competence to address student concerns about harmful interactions with peers across race/ethnicity. The Penn Experience Course establishes common language and concepts to facilitate difficult conversations about racism in the classroom and clinical spaces. METHODS The course included six modules addressing the history of racism in the Philadelphia area and at the University of Pennsylvania: implicit bias and microaggressions; racism and other forms of oppression; gender identity and sexuality; construction of whiteness and white supremacy ideology; cultural humility, disparities, and equity; and access in healthcare. Students completed pre- and post-course surveys about their likelihood of engaging with the neighborhood surrounding Penn, confidence discussing the topics covered, and general experience with the course. RESULTS Four hundred forty-nine students completed post-course surveys, 220 of which could be linked to precourse survey responses. Overwhelmingly, students reported a positive experience with the course, an increase in their likelihood to engage with the Penn neighborhood, and increased confidence in discussing course topics with peers. Many students suggested incorporating synchronous discussion, while a smaller group expressed resentment about the focus on whiteness, white fragility, and anti-Black racism. Several students of color expressed concern that the course centered the learning needs of white students. CONCLUSION Asynchronous online content offers an effective and efficient way of teaching dental students about the basics of cultural competence. Educators should anticipate resistance from some white students and the distinct learning needs of students of color.
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Affiliation(s)
- Beverley A Crawford
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Amy Hillier
- University of Pennsylvania School of Social Policy and Practice, Philadelphia, Pennsylvania, USA
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Pang J, Navejar N, Sánchez JP. Mistreatment in Residency: Intervening With the REWIND Communication Tool. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11245. [PMID: 35539005 PMCID: PMC9038987 DOI: 10.15766/mep_2374-8265.11245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There is a lack of curricula addressing the alarming rates of resident physician mistreatment. As the ACGME works to address diversity, equity, and inclusion in GME, there has been increasing attention paid to the issue of mistreatment. Previous studies have noted a high prevalence of mistreatment within GME. Despite this, there are few published interventions to address the mistreatment of residents. We developed a workshop for residents to provide an overview of mistreatment in residency and teach them REWIND (relax, express, why, inquire, negotiate, determine), a communication tool to address mistreatment directly. METHODS We designed a 60-minute workshop for residents with didactics on mistreatment in GME, followed by three case discussions. Four case scenarios were developed to represent different types of mistreatment and situations. We implemented the workshop twice and asked participants to self-rate proficiency around the workshop objectives with pre- and postsurveys. RESULTS A total of 11 GME learners completed both the pre- and postsurveys between the two workshop implementations. GME learners who responded demonstrated significantly higher self-rated proficiency on each objective postworkshop compared to preworkshop (p < .05). Free responses on the survey demonstrated that participants particularly enjoyed the case discussions and wanted more practice with REWIND. DISCUSSION Our workshop improved participant self-rated proficiency around the mistreatment of resident physicians. The workshop can be used in the future as part of a multifaceted institutional response to mistreatment.
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Affiliation(s)
- Joyce Pang
- Third-Year Resident, Department of Surgery, University of New Mexico School of Medicine
| | | | - John Paul Sánchez
- Professor and Vice Chair, Department of Emergency Medicine, University of New Mexico School of Medicine; Executive Associate Vice Chancellor, Health Sciences Center Office for Diversity, Equity, and Inclusion, University of New Mexico School of Medicine
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Kristoffersson E, Hamberg K. "I have to do twice as well" - managing everyday racism in a Swedish medical school. BMC MEDICAL EDUCATION 2022; 22:235. [PMID: 35365131 PMCID: PMC8973650 DOI: 10.1186/s12909-022-03262-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/11/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Mounting evidence suggests that medical students from cultural/ethnic minority backgrounds face recurring and more or less subtle racist oppression, i.e., everyday racism. Insights into how they handle these inequalities, though, are scarce - especially in a Swedish context. In this interview study we therefore explored and analyzed the strategies used by racialized minority medical students to manage episodes of everyday racism - and their underlying motives and considerations. METHODS Individual interviews were carried out with 15 medical students (8 women, 7 men) who self-identified as having ethnic- or cultural minority backgrounds. Inspired by constructivist grounded theory, data were collected and analyzed simultaneously. RESULTS Participants strove to retain their sense of self as active students and professional future physicians - as opposed to passive and problematic 'Others'. Based on this endeavor, they tried to manage the threat of constraining stereotypes and exclusion. Due to the power relations in medical education and clinical placement settings as well as racialized students' experience of lacking both credibility and support from bystanders, few dared to speak up or report negative treatment. Instead, they sought to avoid racism by withdrawing socially and seeking safe spaces. Or, they attempted to adopt a professional persona that was resistant to racial slights. Lastly, they tried to demonstrate their capability or conform to the majority culture, in attempts to refute stereotypes. CONCLUSIONS Racism is not caused by the exposed individuals' own ways of being or acting. Therefore, behavioral changes on the part of minority students will not relieve them from discrimination. Rather, strategies such as adaptation and avoidance run the risk of re-inscribing the white majority as the norm for a medical student. However, as long as racialized minority students stand alone it is difficult for them to act in any other way. To dismantle racism in medical education, this study indicates that anti-racist policies and routines for handling discrimination are insufficient. School management should also acknowledge racially minoritized students' experiences and insights about racist practices, provide students and supervisors with a structural account of racism, as well as organize training in possible ways to act as a bystander to support victims of racism, and create a safer working environment for all.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden.
- Umeå Centre for Gender Studies, Umeå University, 901 87, Umeå, Sweden.
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden
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Fleming E, Mertz E, Jura M, Kottek A, Gates P. American Indian/Alaska Native, Black, and Hispanic dentists' experiences of discrimination. J Public Health Dent 2022; 82 Suppl 1:46-52. [PMID: 35726466 PMCID: PMC9543282 DOI: 10.1111/jphd.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination. METHODS This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers' education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination. RESULTS Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type. CONCLUSIONS Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.
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Affiliation(s)
- Eleanor Fleming
- Department of Dental Public HealthUniversity of Maryland School of DentistryBaltimoreMarylandUSA
| | - Elizabeth Mertz
- Healthforce Center, Affiliate FacultyPhilip R. Lee Institute for Health Policy Studies, UCSF School of DentistrySan FranciscoCaliforniaUSA
| | - Matthew Jura
- University of California San FranciscoPhillip R. Lee Institute for Health Policy StudiesSan FranciscoCaliforniaUSA
| | - Aubri Kottek
- Preventive and Restorative Dental SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Paul Gates
- Department of DentistryDurhamNorth CarolinaUSA
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Walters M, Alonge T, Zeller M. Impact of COVID-19 on Medical Education: Perspectives From Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S40-S48. [PMID: 34789656 PMCID: PMC8855758 DOI: 10.1097/acm.0000000000004525] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This article provides an overview of issues facing medical students in such key areas as communication, preclinical and clinical education, increased isolation, disruption to time-based curricula, inequities in virtual learning, racial trauma, medical student activism, increased conversations surrounding race and racism, LGBTQIA+ students, dual-degree students, and the virtual residency cycle. This article described challenges navigated by medical students during the COVID-19 pandemic, as well as triumphs resulting from the disruption and actionable recommendations in key areas. While the pandemic presented new challenges for medical students, it also uncovered or exacerbated long-standing problems. The intent is for medical schools and institutions to use these recommendations to create learning environments that do not depend on medical student resilience. The main takeaways for medical schools are to: (1) maintain an individualized and learner-centered ethos while remaining dynamic, flexible, and ready to embrace both immediate and incremental changes; (2) maintain open lines of communication; (3) implement policies and practices that support students' academic, physical, and mental well-being; (4) engage and support students who bear historically disadvantaged identities on the basis of race, ethnicity, sexual orientation, gender, or disability; and (5) support creative and collaborative partnerships between medical institutions and students to ensure the ongoing evolution of medical education to meet the needs of learners and patients.
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Affiliation(s)
- Marie Walters
- M. Walters is a first-year emergency medicine resident, Indiana University School of Medicine, Indianapolis, Indiana
| | - Taiwo Alonge
- T. Alonge is a first-year psychiatry resident, Yale School of Medicine, New Haven, Connecticut
| | - Matthew Zeller
- M. Zeller is a first-year surgical resident, Sinai Hospital of Baltimore, Baltimore, Maryland
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Relationships of Sexual Orientation Microaggression with Anxiety and Depression among Lesbian, Gay, and Bisexual Taiwanese Youth: Self-Identity Disturbance Mediates but Gender Does Not Moderate the Relationships. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412981. [PMID: 34948591 PMCID: PMC8701819 DOI: 10.3390/ijerph182412981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022]
Abstract
The aims of this cross-sectional survey study were to examine the association between sexual orientation microaggression and anxiety and depression among young adult lesbian, gay, and bisexual (LGB) individuals in Taiwan, as well as to examine the mediating effect of self-identity disturbance and the moderating effect of gender. In total, 1000 self-identified LGB individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, self-identity disturbance was assessed using the Self-Concept and Identity Measure, anxiety was assessed using the State subscale on the Chinese version of the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. Structural equation modeling (SEM) was used to examine relationships between the variables. The SEM results demonstrated that sexual orientation microaggression was directly associated with increased anxiety and depression, as well as being indirectly associated with increased anxiety and depression via the mediation of self-identity disturbance among young adult LGB individuals. Gender did not moderate the relationships between any of the variables. Both sexual orientation microaggression and self-identity disturbance warrant program interventions for enhancing mental health among LGB individuals.
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Goulart MF, Huayllani MT, Balch Samora J, Moore AM, Janis JE. Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e4062. [PMID: 34963876 PMCID: PMC8694515 DOI: 10.1097/gox.0000000000004062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training. METHODS A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson's chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables. RESULTS One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees (P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees (P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees (P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1-2 and 3-4 integrated residents (P < 0.05). CONCLUSIONS Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.
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Affiliation(s)
- Micheline F. Goulart
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Maria T. Huayllani
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julie Balch Samora
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Amy M. Moore
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- From the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Fisher HN, Chatterjee P, Shapiro J, Katz JT, Yialamas MA. "Let's Talk About What Just Happened": a Single-Site Survey Study of a Microaggression Response Workshop for Internal Medicine Residents. J Gen Intern Med 2021; 36:3592-3594. [PMID: 33479935 PMCID: PMC7819694 DOI: 10.1007/s11606-020-06576-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Herrick N Fisher
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, USA.
| | - Paula Chatterjee
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, Philadelphia, PA, USA
| | - Jo Shapiro
- Harvard Medical School, Boston, USA
- Department of Anesthesia, Pain and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Joel T Katz
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
| | - Maria A Yialamas
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, USA
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York M, Langford K, Davidson M, Hemingway C, Russell R, Neeley M, Fleming A. Becoming Active Bystanders and Advocates: Teaching Medical Students to Respond to Bias in the Clinical Setting. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11175. [PMID: 34485695 PMCID: PMC8374028 DOI: 10.15766/mep_2374-8265.11175] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/20/2021] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Incidents of bias and microaggressions are prevalent in the clinical setting and are disproportionately experienced by racial minorities, women, and medical students. These incidents contribute to burnout. Published efforts to address these incidents are growing, but gaps remain regarding the long-term efficacy of these curricular models. We developed and longitudinally evaluated a workshop that taught medical students a framework to respond to incidents of bias or microaggressions. METHODS In October 2019, 102 Vanderbilt core clerkship medical students participated in an hour-long, interactive, case-based workshop centered around the 3 D's response behavior framework: (1) direct, (2) distract, and (3) delegate. Participants were surveyed before and after the training, and both qualitative and quantitative data were collected. A refresher workshop was offered 8 months later, which added two additional D's: delay and display discomfort. RESULTS After the workshop, respondents' knowledge of the assessed topics improved significantly, as did their confidence in addressing both personally experienced and witnessed incidents. Respondents initially indicated a high likelihood of using response behaviors to address incidents. The workshop did not consistently modify behavioral responses to experienced or witnessed incidents. Ninety-one percent of respondents agreed the workshop was effective. DISCUSSION This workshop provided an effective curriculum to sustainably improve participant knowledge and confidence in responding to incidents of bias and microaggressions. This resource can be adopted by educators at other institutions.
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Affiliation(s)
- Michelle York
- Medical Student, Vanderbilt University School of Medicine
| | - Kyle Langford
- Medical Student, Vanderbilt University School of Medicine
| | - Mario Davidson
- Assistant Professor, Department of Biostatistics, Vanderbilt University Medical Center
| | - Celeste Hemingway
- Assistant Professor, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center
| | - Regina Russell
- Assistant Professor, Department of Medical Education and Administration, Vanderbilt University
| | - Maya Neeley
- Assistant Professor, Department of Pediatrics, Vanderbilt University Medical Center
| | - Amy Fleming
- Associate Dean of Student Affairs, Vanderbilt University School of Medicine
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James E, Evans M, Mi M. Leadership Training and Undergraduate Medical Education: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2021; 31:1501-1509. [PMID: 34026307 PMCID: PMC8131083 DOI: 10.1007/s40670-021-01308-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 05/09/2023]
Abstract
The purpose of this scoping review is to fill the gap in understanding the current status of intervention-based studies regarding leadership training in undergraduate medical education. As of late, there is an increased focus on the role of physicians as leaders in their fields, and communities. In order to evaluate these studies, both the PubMed and ERIC databases were searched, and an ultimate total of 35 articles methodologies were evaluated for their general methodology, curricular content, specific teaching methods, and evaluation methodologies. There were a number of trends identified, as well as remaining gaps. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01308-9.
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Affiliation(s)
- Eric James
- Oakland University, William Beaumont School of Medicine, Rochester, MI USA
| | - Mallory Evans
- Oakland University, William Beaumont School of Medicine, Rochester, MI USA
| | - Misa Mi
- Department of Foundational Medical Studies, Oakland University, William Beaumont School of Medicine, Rochester, MI USA
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Gonzalez CM, Walker SA, Rodriguez N, Noah YS, Marantz PR. Implicit Bias Recognition and Management in Interpersonal Encounters and the Learning Environment: A Skills-Based Curriculum for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11168. [PMID: 34277934 PMCID: PMC8275619 DOI: 10.15766/mep_2374-8265.11168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/05/2021] [Indexed: 05/21/2023]
Abstract
Introduction Students desire instruction in skill development to address both their own implicit biases and bias perceived in the learning environment. Curricula to date achieve strategy identification through reflection and discussion but do not provide opportunity for personally relevant skill development and practice in implicit bias recognition and management. To address this gap, we developed and evaluated a skills-based elective in implicit bias recognition and management focused on learners' own interpersonal interactions, including patient encounters, and perceived bias in the learning environment. Method Fifteen first-year medical students completed the nine-session elective over three annual offerings. Each session lasted 1.5 hours. Curriculum development was informed by published frameworks and transformative learning theory. Direct observation of student performances in role-plays and other active learning exercises constituted the formative assessment. Program evaluation focused on the impact of instruction through pre- and posttests, along with analysis of notes taken by the investigative team, including notes on formative assessments. Results Students engaged with all aspects of instruction, including role-plays. Pretest/posttest results demonstrated increased self-reported knowledge and comfort in addressing perceived bias. Formative assessment demonstrated students' skill development in safely and respectfully addressing perceived bias in the learning environment without endangering their relationships with supervisors. Discussion Skills developed-addressing bias in interpersonal encounters and perceived bias in clinical and teaching encounters-are relevant to learners throughout their careers. This course is relevant to medical students and trainees at various experience levels and could serve as a template for novel, skills-based curricula across health professions.
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Affiliation(s)
- Cristina M. Gonzalez
- Professor, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
| | - Sydney A. Walker
- Medical Student, Oregon Health & Science University School of Medicine
| | - Natalia Rodriguez
- Medical Student, Perelman School of Medicine at the University of Pennsylvania
| | | | - Paul R. Marantz
- Associate Dean for Clinical Research Education and Professor, Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine
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Gonzalez CM, Nava S, List J, Liguori A, Marantz PR. How Assumptions and Preferences Can Affect Patient Care: An Introduction to Implicit Bias for First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11162. [PMID: 34263027 PMCID: PMC8236500 DOI: 10.15766/mep_2374-8265.11162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/04/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Instruction in implicit bias is becoming prevalent across the spectrum of medical training. Little education exists for preclinical students, and guidance for faculty to facilitate such education is minimal. To address these gaps, we designed and delivered a single session for incoming first-year medical students and developed a facilitator training program. METHODS One faculty member delivered a 1-hour, multimedia, interactive lecture to all first-year medical students. Students subsequently met in small groups with trained facilitators. Activities included reflection, guided debriefing, and strategy identification to become aware of when they might be making an assumption causing them to jump to a conclusion about someone. The program evaluation consisted of aggregated student strategies and facilitator feedback during postsession debriefs, both analyzed through thematic analysis. RESULTS We delivered instruction to 1,098 students. Student strategies resulted in three themes: (1) humility, (2) reflection, and (3) partnering. The postsession debriefs uncovered opportunities to enhance the session. Lessons learned included presenting material to an entire class at once, allowing students to engage in dynamic discussion in the small groups, eliminating anonymous polling in the small groups, and highlighting management of implicit bias as essential to professional development. DISCUSSION Our instructional design enabled first-year medical students to identify at least one strategy to use when implicit biases are activated. The large-group session was deliverable by one faculty member, and volunteers successfully facilitated small-group sessions after only one training session, making this model a feasible innovation to reach an entire medical school class at the same time.
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Affiliation(s)
- Cristina M. Gonzalez
- Professor, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Stephanie Nava
- Research Assistant, Department of Medicine, Albert Einstein College of Medicine
| | - Julie List
- Principal Associate, Department of Family and Social Medicine, Albert Einstein College of Medicine
| | - Alyssa Liguori
- Research Assistant, Department of Medicine, Albert Einstein College of Medicine
| | - Paul R. Marantz
- Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine; Professor, Department of Medicine, Albert Einstein College of Medicine; Associate Dean for Clinical Research Education, Albert Einstein College of Medicine
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Rodriguez N, Kintzer E, List J, Lypson M, Grochowalski JH, Marantz PR, Gonzalez CM. Implicit Bias Recognition and Management: Tailored Instruction for Faculty. J Natl Med Assoc 2021; 113:566-575. [PMID: 34140145 DOI: 10.1016/j.jnma.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implicit bias instruction is becoming more prevalent across the continuum of medical education. Little guidance exists for faculty on recognizing and debriefing about implicit bias during routine clinical encounters. OBJECTIVE To assess the impact and feasibility of single seminars on implicit bias and the approach to its management in clinical settings. METHODS Between September 2016 and November 2017, the authors delivered five departmental/divisional grand rounds across three different academic medical centers in New York, USA. Instruction provided background information on implicit bias, highlighted its relevance to clinical care, and discussed proposed interventions. To evaluate the impact of instruction participants completed a twelve-item retrospective pre-intervention/post-intervention survey. Questions related to comfort and confidence in recognizing and managing implicit bias, debriefing with learners, and role-modeling behaviors. Participants identified strategies for recognizing and managing potentially biased events through free text prompts. Authors qualitatively analyzed participants' identified strategies. RESULTS We received 116 completed surveys from 203 participants (57% response rate). Participants self-reported confidence and comfort increased for all questions. Qualitative analysis resulted in three themes: looking inward, looking outward, and taking action at individual and institutional levels. CONCLUSION After a single session, respondents reported increased confidence and comfort with the topic. They identified strategies relevant to their professional contexts which can inform future skills-based interventions. For healthcare organizations responding to calls for implicit bias training, this approach has great promise. It is feasible and can reach a wide audience through usual grand rounds programming, serving as an effective early step in such training.
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Affiliation(s)
- Natalia Rodriguez
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Emily Kintzer
- Department of Obstetrics and Gynecology, Montefiore Medical Center, United States
| | - Julie List
- Department of Family and Social Medicine, Albert Einstein College of Medicine, United States
| | - Monica Lypson
- F. Edward Hébert School of Medicine, George Washington University School of Medicine and Health Sciences, University of Michigan Medical School, Uniformed Services University of the Health Sciences, United States
| | | | - Paul R Marantz
- Department of Epidemiology & Population Health, Department of Medicine, Albert Einstein College of Medicine, United States
| | - Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, United States.
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Gonzalez CM, Noah YS, Correa N, Archer-Dyer H, Weingarten-Arams J, Sukhera J. Qualitative analysis of medical student reflections on the implicit association test. MEDICAL EDUCATION 2021; 55:741-748. [PMID: 33544914 PMCID: PMC8119345 DOI: 10.1111/medu.14468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback. METHODS Medical students in Bronx, NY, USA, participated in one 90-minute session on implicit bias. The focus of analysis for this study is the post-session narrative assignment inviting them to take the race-based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de-identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology. RESULTS Medical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced. CONCLUSION Despite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students' acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.
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Affiliation(s)
- Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yuliana S Noah
- Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA
| | - Nereida Correa
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, NY, USA
| | - Heather Archer-Dyer
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Javeed Sukhera
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Afolabi T, Borowsky HM, Cordero DM, Paul DW, Said JT, Sandoval RS, Davis D, Ölveczky D, Chatterjee A. Student-Led Efforts to Advance Anti-Racist Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:802-807. [PMID: 33711839 DOI: 10.1097/acm.0000000000004043] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Over the past decade, medical schools across the United States have increasingly dedicated resources to advancing racial and social justice, such as by supporting diversity and inclusion efforts and by incorporating social medicine into the traditional medical curricula. While these changes are promising, the academic medicine community must apply an anti-racist lens to every aspect of medical education to equip trainees to recognize and address structural inequities. Notably, organizing and scholarly work led by medical students has been critical in advancing anti-racist curricula. In this article, the authors illustrate how student activism has reshaped medical education by highlighting examples of student-led efforts to advance anti-racist curricula at Harvard Medical School (HMS) and at the University of California, San Francisco (UCSF) School of Medicine. HMS students collaborated with faculty to address aspects of existing clinical practice that perpetuate racism, such as the racial correction factor in determining kidney function. They also responded to the existing curricula by noting missed opportunities to discuss structural racism, and they planned supplemental sessions to address these gaps. At UCSF, students identified specific avenues to improve the rigor of social medicine courses and developed new curricula to equip students with skills to confront and work to dismantle racism. The authors describe how HMS students, in an effort to improve the learning environment, developed a workshop to assist students in navigating microaggressions and discrimination in the clinical setting. At UCSF, students partnered with faculty and administration to advocate pass/fail grading for clerkships after university data revealed racial disparities in students' clerkship assessments. In reviewing these examples of students' advocacy to improve their own curricula and learning environments, the authors aim to provide support for students and faculty pursuing anti-racist curricular changes at their own institutions.
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Affiliation(s)
- Titilayo Afolabi
- T. Afolabi is a fourth-year student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-1273-2183
| | - Hannah M Borowsky
- H.M. Borowsky is a fourth-year student, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0001-8779-7873
| | - Daniella M Cordero
- D.M. Cordero is a fourth-year student, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0003-4207-5708
| | - Dereck W Paul
- D.W. Paul Jr is a fourth-year student, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0001-6099-5933
| | - Jordan Taylor Said
- J.T. Said is a fourth-year student, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-0357-6916
| | - Raquel Sofia Sandoval
- R.S. Sandoval is a fourth-year student, Harvard Medical School and Harvard Kennedy School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-0770-4030
| | - Denise Davis
- D. Davis is a clinical professor of medicine, University of California, San Francisco, specialist for diversity, University of California, San Francisco, and vice president, Diversity, Equity, and Inclusion, Academy of Communication in Healthcare, San Francisco, California
| | - Daniele Ölveczky
- D. Ölveczky is a physician, Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), inclusion officer, Department of Medicine, BIDMC, and assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-8972-4483
| | - Avik Chatterjee
- A. Chatterjee is a physician, Boston Health Care for the Homeless Program, assistant professor, Boston University School of Medicine and Boston Medical Center, part-time lecturer, Harvard Medical School, associate epidemiologist, Division of Global Health Equity, Department of Internal Medicine, Brigham and Women's Hospital, and faculty supervisor, the Racial Justice Coalition, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8437-6774
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Ellison J, Gunther C, Campbell MB, English R, Lazarus C. Critical Consciousness as a Framework for Health Equity-Focused Peer Learning. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11145. [PMID: 33937521 PMCID: PMC8079426 DOI: 10.15766/mep_2374-8265.11145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Recognizing the need to teach concepts of health equity, diversity, and inclusion as a part of medical students' preclinical training, we developed a series of workshops in the first year of medical school that introduced students to issues of discrimination and inequity and their effects on health outcomes. This student-led, faculty-supported project, known as Critical Consciousness in Medicine (CCM), adopted critical consciousness as a guiding principle for student learning. METHODS Over the course of the 2018-2019 academic year, student leaders developed and delivered five 2-hour workshops to 197 first-year students, with the assistance of student facilitators and input and guidance from faculty advisors. Workshops involved a mix of whole-class presentations and small-group discussions. Session topics included identity and interpersonal relationships, privilege, health disparities, and implicit bias. RESULTS Paired t-test analysis showed statistically significant growth in student self-ratings related to CCM learning objectives as measured in the end-of-year pre-/postsurvey. Student comments in year-end reflections further suggested learning, self-assessment, growth, and appreciation for the workshops' place in the preclinical curriculum. DISCUSSION This project modeled a student-faculty partnership for approaching diversity, inclusion, and health equity in medical education and highlighted the role of students as leaders in educating their peers. The CCM workshop series demonstrated high acceptability as a component of preclinical medical education and may increase student engagement around social issues in health care. CCM also illustrated the promise of using critical consciousness as an approach to educating medical students about equity, diversity, and inclusion.
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Affiliation(s)
- Jonte Ellison
- Fourth-Year Medical Student, LSU Health New Orleans School of Medicine
| | - Chris Gunther
- Fourth-Year Medical Student, LSU Health New Orleans School of Medicine
| | - Mary Beth Campbell
- Graduate Student, Tulane University School of Public Health and Tropical Medicine
| | - Robin English
- Assistant Dean for Undergraduate Medical Education, LSU Health New Orleans School of Medicine
| | - Cathy Lazarus
- Associate Dean for Student Affairs, LSU Health New Orleans School of Medicine
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Abstract
PURPOSE OF REVIEW Microaggressions are daily commonplace, subtle behaviors and attitudes toward others that arise from conscious or unconscious bias. Not only can microaggressions affect one's access to power, resources, and opportunity, but they could also contribute to the persistent disparities faced by marginalized groups among healthcare professionals as well as patients. RECENT FINDINGS Physicians, especially those in perioperative specialties, commonly have distress during their medical training. Workplace mistreatment, such as discrimination, has been commonly reported by residents across multiple specialties. Microaggressions also impact patient care as they can influence decisions of medical professionals toward a person or group of people. SUMMARY This review offers education on the correlation of microaggression and unconscious bias to health disparities, provides tools to address microaggressions as a bystander, and outlines processes for institutional improvement.
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Affiliation(s)
- Odinakachukwu Ehie
- Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Iyabo Muse
- Department of Anesthesiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York
| | - LaMisha Hill
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Bastien
- Department of Anesthesiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York
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Mezu-Ndubuisi OJ. Unmasking Systemic Racism and Unconscious Bias in Medical Workplaces: A Call to Servant Leadership. J Am Heart Assoc 2021; 10:e018845. [PMID: 33779239 PMCID: PMC8174363 DOI: 10.1161/jaha.120.018845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Olachi J Mezu-Ndubuisi
- Department of Pediatrics University of Wisconsin School of Medicine and Public Health Madison WI.,Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health Madison WI
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Ackerman-Barger K, Jacobs NN, Orozco R, London M. Addressing Microaggressions in Academic Health: A Workshop for Inclusive Excellence. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11103. [PMID: 33598543 PMCID: PMC7880252 DOI: 10.15766/mep_2374-8265.11103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Health profession schools have acknowledged the need for a diverse workforce by increasing diversity in recruitment, but little has been done to build inclusive excellence in learning environments. Microaggressions and other forms of mistreatment can increase stress levels and depression and negatively impact academic performance. To increase student performance, retention, and wellness, mitigating microaggressions is needed to promote an inclusive culture. METHODS We designed this workshop as a framework to think critically about microaggressions, how they impact the health professions academic environment, and how administrators, faculty, and students can promote inclusion excellence. The workshop included a presentation discussing microaggression theory, seven cases describing microaggressions in the health professions education environment, and discussion and facilitator guides. Cases were based on prior research conducted by the primary author and upon interactions authors shared from their professional experience. Participants completed pre- and postsurveys. RESULTS During six workshops at three different institutions, 138 out of 190 participants (73% response rate), including nursing and medicine faculty, students, and leadership, completed the pre- and postsurveys. Pre- and posttraining measurements found statistically significant improvements in participants' knowledge of the impact of microaggressions, self-efficacy in responding to microaggressions, and commitment to being an active bystander in the face of microaggressions. Participants were highly satisfied with the training. DISCUSSION This humanistic, case-based learning curriculum allows facilitators to guide faculty, student, and leadership conversations to build skills to promote inclusion excellence through preventing microaggressions, repairing and reestablishing relationships, and restoring reputations once microaggressions occur.
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Affiliation(s)
- Kupiri Ackerman-Barger
- Associate Dean of Health Equity, Diversity and Inclusion, Betty Irene Moore School of Nursing at University of California, Davis; Co-Director, Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine
- Corresponding author:
| | - N. Nicole Jacobs
- Associate Dean of Diversity and Inclusion, Office of Diversity and Inclusion, University of Nevada, Reno, School of Medicine
| | - Regina Orozco
- Doctoral Student, Betty Irene Moore School of Nursing at University of California, Davis
| | - Maya London
- Junior Specialist, Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine
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Hock LE, Barlow PB, Scruggs BA, Oetting TA, Martinez DA, Abràmoff MD, Shriver EM. Tools for Responding to Patient-Initiated Verbal Sexual Harassment: A Workshop for Trainees and Faculty. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11096. [PMID: 33598539 PMCID: PMC7880260 DOI: 10.15766/mep_2374-8265.11096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/05/2020] [Indexed: 06/10/2023]
Abstract
Introduction Patients are the most common source of gender-based harassment of resident physicians, yet residents receive little training on how to handle it. Few resources exist for residents wishing to address patient-initiated verbal sexual harassment themselves. Methods We developed, taught, and evaluated a 50-minute workshop to prepare residents and faculty to respond to patient-initiated verbal sexual harassment toward themselves and others. The workshop used an interactive lecture and role-play scenarios to teach a tool kit of communication strategies for responding to harassment. Participants completed retrospective pre-post surveys on their ability to meet the learning objectives and their preparedness to respond. Results Ninety-one participants (57 trainees, 34 faculty) completed surveys at one of five workshop sessions across multiple departments. Before the workshop, two-thirds (67%) had experienced patient-initiated sexual harassment, and only 28 out of 59 (48%) had ever addressed it. Seventy-five percent of participants had never received training on responding to patient-initiated sexual harassment. After the workshop, participants reported significant improvement in their preparedness to recognize and respond to all forms of patient-initiated verbal sexual harassment (p < .01), with the greatest improvements noted in responding to mild forms of verbal sexual harassment, such as comments on appearance or attractiveness or inappropriate jokes (p < .01). Discussion This workshop fills a void by preparing residents and faculty to respond to verbal sexual harassment from patients that is not directly observed. Role-play and rehearsal of an individualized response script significantly improved participants' preparedness to respond to harassment toward themselves and others.
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Affiliation(s)
- Lauren E. Hock
- Resident Physician, Department of Ophthalmology and Visual Sciences, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Patrick B. Barlow
- Assistant Professor, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Brittni A. Scruggs
- Vitreoretinal Surgery Fellow, Casey Eye Institute, Oregon Health & Science University
| | - Thomas A. Oetting
- Clinical Professor and Ophthalmology Residency Program Director, Department of Ophthalmology and Visual Sciences, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Denise A. Martinez
- Associate Dean, Office of Diversity, Equity, and Inclusion, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Michael D. Abràmoff
- Professor, Department of Ophthalmology and Visual Sciences, University of Iowa Roy J. and Lucille A. Carver College of Medicine
| | - Erin M. Shriver
- Clinical Professor, Department of Ophthalmology and Visual Sciences, University of Iowa Roy J. and Lucille A. Carver College of Medicine
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Kristoffersson E, Rönnqvist H, Andersson J, Bengs C, Hamberg K. "It was as if I wasn't there" - Experiences of everyday racism in a Swedish medical school. Soc Sci Med 2021; 270:113678. [PMID: 33434719 DOI: 10.1016/j.socscimed.2021.113678] [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] [Revised: 12/10/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore and analyze how cultural/ethnic minority students at a Swedish medical school perceive and make sense of educational experiences they viewed as related to their minority position. We interviewed 18 medical students (10 women, and 8 men), who self-identified as coming from minority backgrounds. Data were collected and analyzed simultaneously, inspired by constructivist grounded theory methodology. The concepts 'everyday racism' and 'racial microaggressions' served as a theoretical framework for understanding how inequities were experienced and understood. Participants described regularly encountering subtle adverse treatment from supervisors, peers, staff, and patients. Lack of support from bystanders was a common dimension of their stories. These experiences marked interviewees' status as 'Other' and made them feel less worthy as medical students. Interviewees struggled to make sense of being downgraded, excluded, and discerned as different, but seldom used terms like being a victim of discrimination or racism. Instead, they found other explanations by individualizing, renaming, and relativizing their experiences. Our results indicate that racialized minority medical students encounter repeated practices that, either intentionally or inadvertently, convey disregard and sometimes contempt based on ideas about racial and/or cultural 'Otherness'. However, most hesitated to name the behaviors and comments experienced as "discriminatory" or "racist", likely because of prevailing ideas about Sweden and, in particular, medical school as exempt from racism, and beliefs that racial discrimination can only be intentional. To counteract this educational climate of exclusion medical school leadership should provide supervisors, students, and staff with theoretical concepts for understanding discrimination and racism, encourage them to engage in critical self-reflection on their roles in racist power relations, and offer training for bystanders to become allies to victims of racism.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden; Umeå Centre for Gender Studies, Umeå University, 901 87, Umeå, Sweden.
| | - Hanna Rönnqvist
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Jenny Andersson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Carita Bengs
- Department of Food, Nutrition and Culinary Science, Umeå University, 901 87, Umeå, Sweden.
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, 901 87, Umeå, Sweden.
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