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美国医学生的边缘化身份、遭受虐待和歧视增加职业倦怠的风险
作者:小柯机器人 发布时间:2022/3/27 19:26:29

美国耶鲁大学公共卫生学院Bethelehem G Teshome团队针对美国医学生的边缘化身份、虐待、歧视和职业倦怠进行了一项横断面调查和回顾性队列研究。相关论文发表在2022年3月22日出版的《英国医学杂志》上。

为了描述医学本科教育中虐待、倦怠与多重边缘身份之间的相关性,研究组在美国医学院协会认证的140所美国医学院中进行了一项横断面调查和回顾性队列研究。参与者为2016年和2017年毕业的30651名医学院毕业生。

根据学生特有的历史上被边缘化身份的独特组合,考虑了自我报告的性别、种族或族裔以及性取向群体。在考虑虐待和歧视的情况下,采用多变量线性回归从两个维度(疲劳和脱离接触)确定独特身份群体与职业倦怠之间的关联,这两个维度由奥尔登堡医学院学生职业倦怠量表测量。

具有三种边缘身份(女性;非白人;女同性恋、男同性恋或双性恋[LGB])的学生报告多次遭受多种类型虐待(88/299)和歧视(92/299)的比例最大。边缘化身份的学生数量越多,其疲惫感的平均得分也越高。

与男性、白人和异性恋学生相比,女性、非白人和LGB学生的平均疲劳得分差异最大,校正后的平均差异为1.96分。虐待和歧视影响了所有身份群体的疲劳得分,但并不能完全解释独特身份群体与职业倦怠之间的关联。

非白人和LGB学生的平均脱离接触分数高于白人和异性恋学生(分别高0.28和0.73分)。相比之下,无论持有何种身份,女生的平均脱离接触分数都较低。在校正了对女生的虐待和歧视后,女生之间的影响变得更大,表明存在负混杂关联。

研究结果表明,在这项关于美国医学生群体的研究中,那些具有多重边缘身份的学生在医学院期间报告了更多的虐待和歧视,这似乎与职业倦怠有关。

附:英文原文

Title: Marginalized identities, mistreatment, discrimination, and burnout among US medical students: cross sectional survey and retrospective cohort study

Author: Bethelehem G Teshome, Mayur M Desai, Cary P Gross, Katherine A Hill, Fangyong Li, Elizabeth A Samuels, Ambrose H Wong, Yunshan Xu, Dowin H Boatright

Issue&Volume: 2022/03/22

Abstract:

Objective To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.

Design Cross sectional survey and retrospective cohort study.

Setting 140 US medical schools accredited by the Association of American Medical Colleges.

Participants 30651 graduating medical students in 2016 and 2017.

Main outcome measures Self-reported sex, race or ethnicity, and sexual orientation groups were considered, based on the unique combinations of historically marginalized identities held by students. Multivariable linear regression was used to determine the association between unique identity groups and burnout along two dimensions (exhaustion and disengagement) as measured by the Oldenburg Burnout Inventory for Medical Students while accounting for mistreatment and discrimination.

Results Students with three marginalized identities (female; non-white; lesbian, gay, or bisexual (LGB)) had the largest proportion reporting recurrent experiences of multiple types of mistreatment (88/299, P<0.001) and discrimination (92/299, P<0.001). Students with a higher number of marginalized identities also had higher average scores for exhaustion. Female, non-white, and LGB students had the largest difference in average exhaustion score compared with male, white, and heterosexual students (adjusted mean difference 1.96, 95% confidence interval 1.47 to 2.44). Mistreatment and discrimination mediated exhaustion scores for all identity groups but did not fully explain the association between unique identity group and burnout. Non-white and LGB students had higher average disengagement scores than their white and heterosexual counterparts (0.28, 0.19 to 0.37; and 0.73, 0.52 to 0.94; respectively). Female students, in contrast, had lower average disengagement scores irrespective of the other identities they held. After adjusting for mistreatment and discrimination among female students, the effect among female students became larger, indicating a negative confounding association.

Conclusion In this study population of US medical students, those with multiple marginalized identities reported more mistreatment and discrimination during medical school, which appeared to be associated with burnout.

DOI: 10.1136/bmj-2021-065984

Source: https://www.bmj.com/content/376/bmj-2021-065984

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj