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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association Between the Proportion of Women on a Conference Planning Committee and the Proportion of Women Speakers at Medical Conferences

This cross-sectional study examines the association of the proportion of women on a medical conference planning committee with the proportion of women speakers at the conference.

Trends in the Proportion of Female Speakers at Medical Conferences in the United States and in Canada, 2007 to 2017

IMPORTANCE

Gender equity is a prominent issue in the medical profession. Representation of female physicians at academic meetings has been identified as an important component of gender equity; however, this topic has not been systematically assessed.

OBJECTIVE

To determine the trend during the last decade in the proportion of speakers who were women at major academic medical conferences held in Canada and in the United States.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional analysis was conducted examining the gender of speakers listed in meeting programs of medical conferences held in Canada and in the United States in 2007 and from 2013 through 2017. Eligible conferences were identified using a sensitive search strategy, and a previously validated tool was used to analyze each meeting speaker list and to assign a proportion of female speakers. Conferences held in English language, hosted in Canada or the United States, and targeted to a physician audience with 100 or more attendees were included. The comparison group was active physicians in Canada and in the United States.

MAIN OUTCOMES AND MEASURES

The mean of the proportion of female speakers at each conference per year.

RESULTS

In total, 181 conferences with 701 individual meetings were analyzed, including 100 medical and 81 surgical specialty conferences. The proportion of women ranged from 0% to 82.6% of all speakers. The mean (SD) proportion of female conference speakers for all meetings analyzed significantly increased from 24.6% (14.6%) for 40 meetings in 2007 to 34.1% (15.1%) for 181 meetings in 2017 (P < .001). The mean proportion of female speakers at medical specialty conferences was 9.8% higher (SE, 1.9%; P < .001) than the mean proportion of female speakers at surgical specialty conferences for all years analyzed. The mean proportion of female speakers at conferences was similar to the mean proportion of active female physicians across all specialties in the United States and in Canada for all years analyzed.

CONCLUSIONS AND RELEVANCE

Although our findings indicate that the proportion of female speakers at medical conferences increased during the last decade, women continue to be underrepresented. Speaker invitation and selection at conferences represent important opportunities to influence gender equity within medicine.