Table 1
Participant Demographics.
| Residency Training Program | Number (total n = 13) |
| Paediatric | 10 |
| Surgical | 3 |
| Gender | |
| Female | 12 |
| Male | 1 |
| Other Non-Dominant Social Identities (n) Muslim (5) LGBTQ (2) Black (2) East Asian (2) South and Southeast Asian (7) Middle Eastern (2) International medical graduate (3) Low socioeconomic status (3) Age (younger or older) (4) PGY1-5 | |
| Reported Dominant Social Identities (identified by participants; * if also held by some participants) Christian (1) Heterosexual* (6) White* (1) Upper socioeconomic status* (1) Able-bodied* (2) Relatives in Medicine (1) The counts in this section only apply to those held by participants. The counts do not include dominant social identities that were attributed to non-participant peers in interviews. | |
Table 2
Experiences Perpetuating Unequal Social Relations, Their Mechanism, and Potential Solutions.
| PARTICIPANT EXPERIENCE OF FEELING LESSER THAN THEIR PEERS | MECHANISM | POTENTIAL SOLUTIONS |
|---|---|---|
| Having their professional and personal identities miscategorized in relation to their marginalized identities | Aversive Discrimination – Microaggressions as a result of implicit biases | Using real examples of micro-aggressions to develop and offer case-based education to both faculty and learners to bring attention to the aversive racist practices operating in their program. These educational interventions could encourage critical reflection practices to reduce bias and prejudice in daily interactions. This example is grounded in empirical studies that demonstrate when aversive racists are made aware of their bias, they reduce their biased behaviours [71]. This intervention is effective because the same studies show that it does not bias the behaviours of those who are already not aversively racist [71]. |
| Participant experiences of microaggressions and other discrimination is mismatched from stated programmatic commitments to EDI | Aversive Discrimination – Supervisors and peers seemed unaware of acting on their implicit bias, in group favouritism | Using a hidden curricular framework to identify misalignments between the formal, informal, and hidden curricula and designing educational interventions to address identified policies and practices that generate misalignments [61]. The interventions above are one such example. Other potential solutions include: ensuring that pathways for reporting learner mistreatment are clear, and program responses are meaningful and accountable [69]; ensuring fairness in selections, promotions, and awards processes [62, 64, 65, 66]; addressing inequities in programmatic assessment that may result from aversive discrimination [63, 66, 68]; the ongoing programmatic tracking of experiences of inclusion and exclusion in all the above categories to generate the empirical evidence for ongoing educational reform [75]. |
| Exclusion from dominant social groups | Aversive Discrimination – Social dominance, in-group favouritism | The residency program invites regular anonymous feedback on resident experiences of inclusion, including examples of what practices and in what contexts these practices generate experiences of belonging or exclusion. Using a standing agenda item educators review this feedback and make adjustments to programming and community building activities that explicitly frame the residency body as an in-group and promote interaction between all residents in the program [72]. |
| Experiencing exclusion because of social events that centre alcohol consumption and holiday scheduling that makes it much more challenging for participants to celebrate cultural holidays or observe religious practices important to them | Systemic Discrimination – the program centers dominant group cultural practices and norms | The residency program encourages different social activities. While the consumption of alcohol is not eliminated, care is taken so that it is not offered in all social activities [77]. The program pro-actively identifies cultural and religious holidays that are important to trainees and shares programmatic mechanisms for requesting that time off [77]. |
| Experiencing exclusion related to perceived censorship related to taboo topics and the neutrality of medical culture | Systemic Discrimination – the professional culture of medicine | Similar to above, case-based educational interventions with real-life examples are used to foster critical consciousness in faculty and learners around their own positionality and how that impacts how they relate to each other and their patients in the learning and work environments. Within the context of this study, exemplar case scenarios could include examples of classism impacting learners or patients or Islamophobia. Examples should be specific to experiences of discrimination and censorship that are relevant and specific to each learning environment. |