Dataset Information

Faculty Physician and Trainee Experiences with Micro- and Macroaggressions: a Qualitative Study.

ABSTRACT:

Background

Micro- and macroaggressions are often stereotype threats that can have detrimental effects on the recipients. Survey data shows that these aggressions are happening. However, there are few qualitative studies on trainees and faculty physicians' experiences with such aggressions and their impact.

Objective

Explore how micro- and macroaggressions impact physician trainees and faculty.

Design, setting, participants

Virtual, one-on-one, semi-structured interviews were conducted between February and September 2021, among 14 physicians and trainees (medical students, residents, fellows, and faculty) at a tertiary, urban, US academic medical center and its associated hospitals. Participants shared their experiences with micro- and macroaggressions in training and the workplace, as well as their thoughts on intervention and education.

Approach

Qualitative interviews; grounded theory approach KEY RESULTS: A total of 14 physicians and trainees (5 faculty, 2 fellows, 5 residents, 2 students; 11 [79%] women) participated. Four themes with multiple subthemes surfaced: definition, the moment an aggression is experienced, aftereffect of an aggression, and education and training. While general definitions of micro- and macroaggressions were similar among participants, some may have overlooked the inclusion of a marginalized group as central to each term. Both types of aggressions had a range of effects on participants, with faculty noting a cumulative effect. Institutional diversity was identified as a key source of support. Ideas on how to combat such acts included mandatory educational programs and policies, with the acknowledgment that much effort and time are necessary to change mindset and culture.

Conclusions

Faculty physicians and medical trainees shared their personal experiences with micro- and macroaggressions during work and training. Participants described various emotions in the moment but also noted that these aggressions often had lasting impacts. They recognized the challenges of finding a solution to micro- and macroaggressions. Institution-wide education was favored by many as a first step.

SUBMITTER: Kay C

PROVIDER: S-EPMC9551013 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Faculty Physician and Trainee Experiences with Micro- and Macroaggressions: a Qualitative Study.

Kay Cynthia C Bernstein Joanne J Yass Natalie N Woodard Jennifer J Tesfatsion Sara S Scholcoff Cecilia C

Journal of general internal medicine 20220215 13

<h4>Background</h4>Micro- and macroaggressions are often stereotype threats that can have detrimental effects on the recipients. Survey data shows that these aggressions are happening. However, there are few qualitative studies on trainees and faculty physicians' experiences with such aggressions and their impact.<h4>Objective</h4>Explore how micro- and macroaggressions impact physician trainees and faculty.<h4>Design, setting, participants</h4>Virtual, one-on-one, semi-structured interviews wer ...[more]

PMID: 35167062

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Project description:ImportanceAs the clinical workforce becomes more diverse, physicians encounter patients who demean them based on social characteristics. Little is known about physicians' perspectives on these encounters and their effects. This knowledge would help develop policies and best practices for institutions and training programs.ObjectiveTo describe the range and importance of encounters with biased patients and the barriers and facilitators to effective responses.Design, setting, and participantsThis qualitative study recruited convenience samples of hospitalist attending physicians, internal medicine residents, and medical students from 3 campuses affiliated with 1 academic medical center. Data were collected from 50 individuals within 13 focus groups from May 9 through October 15, 2018. Focus groups were conducted using open-ended probes, audiotaped, and transcribed. Participants used their own definition of biased patient behavior. Each transcript was independently coded by at least 2 investigators. Data were analyzed from May 2018 through February 2019.Main outcomes and measuresMajor themes associated with types of encounter, importance to the participant, and barriers and facilitators to effective responses were abstracted through the constant comparative approach.ResultsOverall, 50 individuals (11 hospitalists, 26 residents, and 13 students) participated; 24 (48%) were nonwhite. At total of 26 participants (52%) identified as women; 22 (44%), as men; and 2 (4%), as gender nonconforming. Reports of biased behavior ranged from patient refusal of care and explicit racist, sexist, or homophobic remarks to belittling compliments or jokes. Targeted physicians reported an emotional toll that included exhaustion, self-doubt, and cynicism. Nontargeted bystanders reported moral distress and uncertainty about how to respond. Participant responses ranged from withdrawal from clinical role to a heightened determination to provide standard of care. Barriers to effective responses included lack of skills, insufficient support from senior colleagues and the institution, and perception of lack of utility associated with responding. Participants expressed a need for training on dealing with biased patients and for clear institutional policies to guide responses.Conclusions and relevanceIn this qualitative study of physicians and medical students, encounters with demeaning patients ranged from refusal of care to belittling jokes and were highly challenging and painful. Addressing biased patient behavior will require a concerted effort from medical schools and hospitals to create policies and trainings conducive to a clinical environment that respects the diversity of patients and physicians alike.

Project description:ImportanceWomen are underrepresented at higher ranks in academic medicine. However, the factors contributing to this disparity have not been fully elucidated. Implicit bias and unconscious mental attitudes toward a person or group may be factors. Although academic medical centers use physician trainee evaluations of faculty to inform promotion decisions, little is known about gender bias in these evaluations. To date, no studies have examined narrative evaluations of medical faculty by physician trainees for differences based on gender.ObjectiveTo characterize gender-associated linguistic differences in narrative evaluations of medical faculty written by physician trainees.Design, setting, and participantsThis retrospective cohort study included all faculty teaching evaluations completed for the department of medicine faculty by medical students, residents, and fellows at a large academic center in Pennsylvania from July 1, 2015, through June 30, 2016. Data analysis was performed from June 1, 2018, through July 31, 2018.Main outcomes and measuresWord use in faculty evaluations was quantified using automated text mining by converting free-text comments into unique 1- and 2-word phrases. Mixed-effects logistic regression analysis was performed to assess associations of faculty gender with frequencies of specific words and phrases present in a physician trainee evaluation.ResultsA total of 7326 unique evaluations were collected for 521 faculty (325 men [62.4%] and 196 women [37.6%]). The individual words art (odds ratio [OR], 7.78; 95% CI, 1.01-59.89), trials (OR, 4.43; 95% CI, 1.34-14.69), master (OR, 4.24; 95% CI, 1.69-10.63), and humor (OR, 2.32; 95% CI, 1.44-3.73) were significantly associated with evaluations of male faculty, whereas the words empathetic (OR, 4.34; 95% CI, 1.56-12.07), delight (OR, 4.26; 95% CI, 1.35-13.40), and warm (OR, 3.45; 95% CI, 1.83-6.49) were significantly associated with evaluations of female faculty. Two-word phrases associated with male faculty evaluations included run rounds (OR, 7.78; 95% CI, 1.01-59.84), big picture (OR, 7.15; 95% CI, 1.68-30.42), and master clinician (OR, 4.02; 95% CI, 1.21-13.36), whereas evaluations of female faculty were more likely to be associated with model physician (OR, 7.75; 95% CI, 1.70-35.39), just right (OR, 6.97; 95% CI, 1.51-32.30), and attention (to) detail (OR, 4.26; 95% CI, 1.36-13.40).Conclusions and relevanceThe data showed quantifiable linguistic differences between free-text comments about male and female faculty in physician trainee evaluations. Further evaluation of these differences, particularly in association with ongoing gender disparities in faculty promotion and retention, may be warranted.

Project description:BackgroundThe American Society of Clinical Nutrition recommends 37 to 44 h of undergraduate medical nutrition education. The Total Health Curriculum at Geisinger Commonwealth School of Medicine (GCSOM) contains 14 h of objective-based nutritional instruction. This study aimed to examine the perceptions of key stakeholders regarding the role of nutrition in medicine and to identify barriers, opportunities for improvement, and roles/responsibilities for innovative implementation of nutrition education.MethodsThis exploratory, qualitative study employed a phenomenological approach and inductive coding process. Purposive sampling recruited medical students, undergraduate medical education (UME) faculty, physicians, and other healthcare professionals at GCSOM and affiliated clinical sites. Semi-structured focus groups and one-on-one interviews were conducted via videoconferencing. Audio recordings were transcribed using NVivo 14. Transcripts were manually reviewed alongside the audio files to ensure accuracy. Data were systematically organized using the qualitative research methodology Rigorous and Accelerated Data Reduction (RADaR). Microsoft Copilot was used to assist with thematic analysis. Outcomes were compared, and consensus was obtained among raters.ResultsTwenty-five individuals were interviewed: 12 UME faculty, five students, and eight healthcare professionals, including two physicians. Participants included 18 females and seven males, aged 23 to 69 years. 92% of participants believed that all physicians should receive nutrition education and 40% felt unsatisfied with their nutritional training. For barriers, the qualitative analysis identified these themes: (1) time constraints, (2) assessment and prioritization, (3) insufficient faculty expertise, and (4) bias and stigma. For improvement opportunities, the qualitative analysis identified these themes: (1) curriculum design, (2) practical application, (3) patient-centered approach, and (4) trainee perceptions. For roles/responsibilities, the qualitative analysis identified these themes: (1) accreditation bodies, (2) stakeholder involvement, (3) public policy and legislation, and (4) multilevel responsibility.ConclusionParticipants acknowledged a need for more medical nutrition education to prepare physicians who are equipped to manage the nutritional needs of patients. They recognized key challenges hindering the advancement of such education, proposed various forms of improvement, and identified roles for successful implementation. Future research will assess community perspectives and expand sample diversity.

Project description:BackgroundThe COVID-19 pandemic resulted in a rapid shift from in-person to virtual care delivery for many medical specialties across Canada. The purpose of this study was to explore the lived experiences of resident physicians and faculty related to teaching, learning and assessment during ambulatory virtual care encounters within the competency-based medical education model.MethodsIn this qualitative phenomenological study, we recruited resident physicians (postgraduate year [PGY] 1-5 trainees) and faculty from the Departments of Surgery and Medicine at Queen's University, Ontario, via purposive sampling. Participants were not required to have exposure to virtual care. Interviews were conducted from September 2020 to March 2021 by 1 researcher, and 2 researchers conducted focus groups via Zoom to explore participants' experiences with the transition to virtual care. These were audio-recorded and transcribed verbatim; qualitative data were analyzed thematically.ResultsThere were 18 male and 19 female participants; 20 were resident physicians and 17 were faculty; 19 were from the Department of Surgery and 18 from the Department of Medicine. All faculty participants had participated in virtual care during ambulatory care; 2 PGY-1 residents in surgery had not actively participated in virtual care, although they had participated in clinics where faculty were using virtual care. The mean age of faculty participants was 38 (standard deviation [SD] 8.6) years, and the mean age of resident physicians was 29 (SD 5.4) years. Overall, 28 interviews and 4 focus groups (range 2-3 participants per group) were conducted, and 4 themes emerged: teaching and learning, assessment, logistical considerations, and suggestions. Barriers to teaching included the lack of direct observations and teaching time, and barriers to assessment included an absence of specific Entrustable Professional Activities (EPAs) and feedback focused on virtual care-related competencies. Logistical challenges included lack of technological infrastructure, insufficient private office space and administrative burdens. Both resident physicians and faculty did not foresee virtual care limiting resident physicians' ability to progress within competency-based medical education. Benefits of virtual care included increased accessibility to patients for follow-up visits, for disclosing patients' results and for out-of-town visits. Suggestions included faculty development, improved access to technology and space, educational guidelines for conducting virtual care encounters, and development of virtual care-specific competencies and EPAs.InterpretationIn the postgraduate program we studied, virtual care imposed substantial barriers on teaching, learning and assessment during the first year of the COVID-19 pandemic. Adapting to new circumstances such as virtual care with suggestions from resident physicians and faculty may help to ensure the continuity of postgraduate medical education throughout the COVID-19 pandemic.

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Dataset Information

Faculty Physician and Trainee Experiences with Micro- and Macroaggressions: a Qualitative Study.

Background

Objective

Design, setting, participants

Approach

Conclusions

Publications

Faculty Physician and Trainee Experiences with Micro- and Macroaggressions: a Qualitative Study.

Similar Datasets

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