The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students

The impact of intersectionality on the experience of medical trainees

Diverse trainees have different training experiences than non-diverse trainees; however, it has not been demonstrated if the number of diverse traits (DTs) (i.e. intersectionality) contributes to worse experiences. Our objective was to understand if the number of DTs a trainee has impacts their training experience. We distributed a survey to medical trainees at Mass General Brigham from 15/12/23 to 15/4/24. DTs were based on race/ethnicity, gender-identity, sexual orientation, birthplace, disability, and highest parental education. A total of 134 responses were obtained. Respondents with 1 DT were more likely to report dissatisfaction with the quality of their training compared to those with 0 DT (P = 0.03). However, this did not remain true for those with 2 or 3+ DT (P = 0.39, P = 0.59). Only respondents with 1 DT disagreed that they had similar opportunities for academic success to those of their peers (P = 0.03) and agreed that they had to work harder than others to be valued equally (P < 0.01). Respondents with 3+ DTs felt that their institution was not diverse (P < 0.01) and racist (P < 0.01) compared to respondents with zero DTs. Therefore, trainees with DTs had different training experiences than trainees with zero DTs, but the number of DTs did not consistently correlate with the quality of their experience. We believe this data is important for administrators to understand how intersectionality effects the trainee experience. Additionally, we believe this data can be used to gauge disparities in education and create an avenue to address issues, such as discrimination, microaggressions, and low retention rate of diverse applicants.

Fostering Equity, Diversity, and Inclusion in medical school admissions through pre-medical mentorship initiatives

ACCESS, a student-led mentorship program affiliated with Schulich School of Medicine & Dentistry, demonstrates a practical, effective approach to addressing inequity in medical education. ACCESS provides personalized, zero-cost mentorship to equity-deserving applicants who face social, financial, and medical barriers that result in underrepresentation in medical school. Our mentorship model showcases significant success in application and interview outcomes, as well as positive feedback from participants. Here, we offer a replicable blueprint for medical schools across Canada. This paper highlights the effectiveness of student-led initiatives in promoting diversity and inclusion in healthcare education and aims to inspire similar programs, fostering a more diverse and inclusive future healthcare workforce.

Enhancing Class Culture: Assessing and Improving the Impact of the "Thriving Together" Workshop for Dalhousie Medical Students

Introduction Collaboration and collegiality in medical school benefit students' experiences and contribute to improved patient care. Learning environments have the potential to foster competition and discourage collaboration. Thriving Together was created to address class dynamics and culture early in medical training. Objective The objective of the study is to thoroughly evaluate the Thriving Together Workshop. Methods The Thriving Together workshop, led by upper-year students, comprises a presentation on class culture, anonymous polling, and small-group case-based exercises. It concludes with a large-group discussion. Pre- and post-workshop survey results were collected via Opinio software. A basic statistical and thematic analysis was conducted to identify response themes.  Results The post-workshop survey response rate was 29 out of 41 attendees (70.7%) in 2022 and 20 out of 55 attendees (36.4%) in 2023. Forty-eight (96.6%) respondents would recommend the workshop to next year's medical cohort, and 44 (89.8%) were interested in a follow-up workshop. Qualitative comments were positive, with feedback focused on attendance, group randomization, and the need for formal resources and post-workshop follow-up. Conclusion The Thriving Together workshop has a positive impact on class culture as evidenced by voluntary attendance and positive survey responses. Strategies to improve attendance will be implemented for upcoming sessions and will focus on refining the workshop to encourage inter-group interactions. In addition, formal resources will be provided to those interested. These adjustments aim to sustain the positive impact of the Thriving Together initiative on medical school culture.

Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis

BACKGROUND

The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation.

STUDY DESIGN

Using critical qualitative inquiry and purposive sampling to ensure sex, geographical, and student or trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semistructured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by 4 analysts.

RESULTS

Twenty-seven participants including 18 medical students and 9 residents, were interviewed. The results showed 3 major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation, and insufficient safe spaces as the key deterrents to program completion. The intersection with sex exponentially increased these identified barriers.

CONCLUSIONS

Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.

Exploring the impact of microaggressions on the genetic counseling student-supervisor relationship: A qualitative study

Genetic counseling students with minoritized identities have reported experiencing microaggressions throughout graduate training, including from fieldwork supervisors. However, the impacts of these fieldwork experiences have not been thoroughly investigated. As supervision is known to be integral to genetic counseling students' skill development and success, the purpose of this qualitative study was to explore the impact of microaggressions on student training, with a specific focus on the supervisory working alliance. To achieve this goal, we conducted 11 interviews with recent genetic counseling graduates (2019-2021) who reported experiencing at least one microaggression from a fieldwork supervisor during graduate school training. Purposive sampling was used to prioritize interviewees who identified as underrepresented in the field due to race, ethnicity, gender identity, sexual orientation, and/or disability status. All interviewees were initially recruited as part of a larger mixed-methods study investigating the frequency and types of microaggressions genetic counseling students experience from fieldwork supervisors. Interview questions explored the time period before a microaggression event, during the event, and after. Qualitative thematic analysis resulted in four themes, three of which are presented in this paper: (1) Impact of microaggressions, (2) Barriers to reporting microaggressions, and (3) Experience reporting microaggressions. Microaggressions from supervisors were shown to impair the psychological well-being of participants and hinder learning opportunities. These experiences led participants to question their choice of profession and avoid time in clinic, ultimately constraining the development of strong supervisory working alliances. Some participants did not report microaggressions due to fear of negative repercussions, and those who did described defensive responses which harmed students' relationships with program leadership. This study reveals opportunities for supervisors to improve student training conditions by centering students' feelings and experiences, increasing open and honest communication, and extending psychosocial tools to supervision. Additionally, graduate programs are encouraged to establish structured reporting protocols for students and evaluate current shortcomings in equity and inclusion initiatives.