Purpose: While there is an emerging body of literature that demonstrates how racism and bias negatively impact the experiences of physicians and trainees from underrepresented groups in medicine in the US, little is known about the experiences of internal medicine trainees and their learning environments. The purpose of this study was to examine these learning environments and explore trainees’ perceptions of race/ethnicity-related topics.
Methods: A 35-item confidential electronic survey was disseminated to trainees from 11 internal medicine training programs in the US. A total of 142 trainees participated. Purposive sampling ensured alignment with 2018 IM trainee demographics by sex, race and ethnicity. Analyses were performed including chi-square, Fisher’s exact tests, and logistic regression.
Results: Key findings reveal 63% of respondents perceived disparities in the care provided to diverse patients. Two in three respondents were confident that their institution would respond to discrimination, but only 1/3 of respondents perceived appropriate reporting mechanisms. Black/African American trainees reported needing to minimize aspects of their race and were less likely to perceive their institutions as being supportive to people of color.
Conclusion: Access to timely information about trainees’ experiences with discrimination and bias in graduate medical education is imperative to disrupt systemic racism and health inequities. Findings suggest a perceived difference in health care provided to minoritized groups, a gap in formal mechanisms for reporting racism and discrimination experienced by trainees, and environments that challenge a sense of belonging. Findings add to current literature exposing the experience of underrepresented trainees in the US.

Keywords: discrimination, bias, graduate medical education, disparities, underrepresented


中文翻译：

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内科住院医师调查：他们的学习环境、偏见和歧视经历以及他们的支持结构

目的：虽然有大量文献表明种族主义和偏见如何对美国医学中代表性不足的群体的医生和学员的经历产生负面影响，但对内科学员的经历及其学习环境知之甚少。本研究的目的是检查这些学习环境并探索学员对种族/民族相关主题的看法。
方法：向来自美国 11 个内科培训项目的学员分发了一项包含 35 个项目的保密电子调查。共有142名学员参加。有目的的抽样确保与 2018 年 IM 学员的性别、种族和民族人口统计数据保持一致。进行的分析包括卡方、Fisher 精确检验和逻辑回归。
结果：主要调查结果显示，63% 的受访者认为向不同患者提供的护理存在差异。三分之二的受访者相信他们的机构会应对歧视，但只有 1/3 的受访者认为有适当的报告机制。黑人/非裔美国学员报告说，他们需要尽量减少种族方面的影响，并且不太可能认为他们的机构支持有色人种。
结论：获得有关受训者在研究生医学教育中遭受歧视和偏见的经历的及时信息对于破坏系统性种族主义和健康不平等至关重要。调查结果表明，向少数族裔群体提供的医疗保健存在明显差异，报告学员所经历的种族主义和歧视的正式机制存在差距，以及挑战归属感的环境。调查结果增加了当前文献，揭示了美国代表性不足的受训者的经历。

关键词：歧视，偏见，研究生医学教育，差距，代表性不足