Aliya Kassam

There remains limited information on racial diversity amongst medical student bodies. Given the lack of demographic data collected for medical student admissions, we sought to understand the ethno-racial identity and capital of medical students across Canada. Our objectives were two-fold: (1) Collect demographic data about medical students across Canada and (2) Apply Bourdieu's theoretical framework of capital to the data. Adopting a pragmatist research paradigm, we collected data on Canadian medical students using an online survey administered to all medical students across 17 Canadian medical schools between April 2021 to December 2022. N = 2805 medical students responded (25.0% response rate). 66.7% identified as women and 1.1% identified as non-binary. Most were single and never married (88%) and without children (93%). 60.6% of participants reported that they are perceived as White, whereas 3.1% reported they are perceived as Black. 8.2% of the respondents identified as having an Indigenous identity, whereas 0.5% reported being perceived as an Indigenous person. Together, 31.4% of the sample self-reported their perceived ethno-racial identity as Black, Indigenous, and Person of Colour (BIPOC). 74% of medical students came from households with incomes over $80,000. Compared to non-Indigenous students, Indigenous students were significantly more likely to report having a physician parent (OR 3.72; 95% CI: 2.78-4.98), sibling (OR 6.34; 95% CI: 4.70-8.55) or romantic partner (OR 2.87; 95% CI: 2.15-3.83). Black students were significantly more likely than White students to have one or both parents (OR 2.49; 95% CI 1.59-3.92), or a sibling (OR 2.48; 95% CI 1.52-4.04) being a physician. Our findings show how forms of capital may act as potential barriers and facilitators to accessing medical education. While there has been progress in increasing the representation of underrepresented medical students through diversity initiatives, ethno-racial disparities may persist.

Background: Family Medicine residents in rural training programs experience a unique set of challenges and rewards, including professional isolation, resource limitations, and increased autonomy. These contextual features deeply influence their personal and professional wellbeing or wellness . The purpose of the study was to map the landscape of wellness resources and initiatives for resident physicians in rural Alberta. Method: Using a critical realist lens, this study followed a qualitatively-driven sequential explanatory mixed methods design collecting both quantitative (survey) and qualitative (interview) data. Family Medicine residents were invited to complete a survey that collected their demographic data and information about their wellness practices. Follow-up interviews using a semi-structured guide were conducted with residents and preceptors in rural clinical sites. Interviews were coded by at least two members of the research team independently. Discrepancies in coding were discussed until consensus was achieved. The context, mechanism, and outcome (CMO) configurations were applied to Bhaskar’s laminated systems model (LSM) to describe the interpretation and integration of both data sources. Results: 27 rural family residents participated in an online survey, with 7 participating in semi-structured interviews. An additional 7 rural preceptors were interviewed to examine resident wellness from their perspective. Most residents reported positive experiences and adequate support from their programs. However, frequent stress and burnout remained a concern for over one-third of residents. Community integration and participation was reported as integral to maintaining wellness for residents, with preceptors leveraging mentoring relationships as a way to support resident wellness. Conclusion: The findings allow medical educators to recognize the systemic and relational conditions that promote resident wellness and support resilience. This could potentially encourage the design of interventions that are attuned to the layered structure of reality, targeting not only individual coping strategies (e.g., self-care) but more importantly structural and systemic reforms, institutional continuity, and relational support systems.

Introduction: Resident physicians may experience psychological trauma both at work and in their personal lives. Injury from trauma can impact learning, patient care, relationships, mental health and well‐being. Residents' experiences of traumatic injury have not been well‐described in the literature. The purpose of this study was to explore residents' lived experiences of psychological traumatic injury. Methods: The research employed a hermeneutic phenomenological methodology. All residents at a single Canadian medical school and support professionals who work with them were invited to participate in semi‐structured interviews. Anonymized transcripts were analysed in duplicate and findings interpreted through discussion amongst the research team. Results: Thirteen residents and three support professionals participated. Four core domains of lived experience within participant narratives were identified, each with multiple dimensions: impacts of traumatic injury (multifaceted, internal reactions, layered judgements), adaptations to traumatic injury (shifts in mindset and behaviour), traumatic injury over time (acknowledging, oscillation, meaning‐making) and modifiers of traumatic injury (previous life experiences, internal resources, contextual circumstances). Three metanarratives intersecting these dimensions of experience were complexity, sociocultural influences and existential tensions. Conclusion: In summary, residents' experiences of trauma and the associated traumatic injury are complex, highly individual and difficult to anticipate or resolve with linear support models. This research will help guide ways to better support residents while addressing problematic aspects of medical education that may contribute to experiences of trauma.

Purpose: American medical students exhibit higher rates of depression, anxiety, and psychological distress than age-matched members of the general population, yet the majority of students do not seek help for these conditions. A necessary precursor to help-seeking is disclosure, or the sharing of one’s diagnosis or symptoms with others. This pilot study aims to explore mental health disclosure decision-making among medical students. Design: Semi-structured qualitative interviews. Setting: Students were interviewed virtually using Zoom. Participants: 20 students enrolled in nine American undergraduate medical education institutions (MD or DO). Method: Interviews were audio-recorded and transcribed. Using Constructivist Grounded Theory (CGT) and iterative cycles of analysis with focused and theoretical coding, a preliminary framework was developed to represent mental health disclosure decision-making among medical students. Results: The proposed framework presents three factors that impact students’ disclosure decisions: Assessing Anticipated Outcomes , Evaluating Priorities , and Determining Appropriate Recipients . The framework also identifies two moderating variables— Disclosure Goals and Severity and Type of Symptom s—that affect students’ perspectives on outcomes and recipients. Conclusion: This pilot study highlights the complexity of student disclosure decision-making. While limited by the small sample size, the results suggest the importance of considering student perspectives on disclosure recipients, communication surrounding disclosure outcomes, and the flexibility of student schedules when pursuing future projects related to medical student well-being and mental health disclosure.

Learner autonomy is essential in medical education, not just as an educational goal but as an ethical priority. Drawing on self‐determination theory (SDT), this Viewpoint differentiates autonomy from independence and emphasizes the need for autonomy support throughout medical training. We explore the ethical imperative of supporting autonomy in medical learners, why current educational models are often inadequate and how educators can adopt practices that respect learner autonomy. The paper concludes with a call for structural changes in medical education, to better align with evidence‐based approaches that foster motivation, professional development and ultimately well‐being.

Objective: Accreditation standards in residency education are calling for initiatives to promote the wellness of resident physicians including the implementation of fatigue risk management plans (FRMPs). We sought to conduct a realist evaluation of a FRMP within a five-year Obstetrics and Gynecology (OBGYN) residency training program in labour and delivery units. Design: Mixed method study design informed by realist inquiry. Setting: A single OBGYN residency program comprised of N=32 resident physicians who provided in-house labour and delivery call at four hospitals across a city of over one million people. Method: Realist inquiry askes what works, for whom, in what circumstances, and why? through examining contexts, mechanisms, and outcomes. We collected quantitative and qualitative data from resident physicians sequentially across three time points. Data were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach. Results: There was n=19 unique participants (60% response rate). Most of the participants identified as women (93.7%), single (56.2%) and without children (93.7%). Participants mean age was 28.5 years and ranged from junior to senior residents. We found no significant difference between median sleepiness scores across three timepoints (p=0.17) however 20% of residents reported starting and ending shifts with high sleepiness scores signaling impairment that is hazardous to both residents and patients. The n=6 resident interview participants, reported overlooking patient details (forgetting to order tests, and delaying care) as well as personal safety issues such as driving home whilst fatigued despite FRMP implementation. Conclusion: Specific aspects of the OBGYN FRMP such as the nap model and nutrition could help with decreasing perceptions of fatigue related to lack of sleep and lack of available food. While FRMPs might be helpful in de-stigmatizing fatigue in residency, FRMPs are unlikely to decrease levels of resident fatigue because of systemic, structural, and cultural barriers.

Purpose There is a pressing need to address all forms of anti-oppression in medicine, given systemic harm and inequities in care and outcomes for patients and health care professionals from equity-deserving groups. Revising definitions of professionalism used in competency-based education can incorporate new professional competencies for physicians to identify and eliminate the root causes of these inequities. This study redefined the CanMEDS Professionalism definition to centre perspectives of equity-deserving groups. Methods In this qualitative study there were two phases. The authors conducted individual semi-structured interviews with participants representing equity-deserving population groups to understand their perspectives on and iteratively build a definition of medical professionalism. Then, the authors undertook a consensus-building process, a modified nominal group technique, using focus groups with community members from equity-deserving groups and healthcare providers to verify findings and arrive at an updated definition of medical professionalism. Results Four main themes were identified: 1) healthcare at the margins; 2) equity-oriented domains of professionalism; 3) structural professionalism; and 4) supporting improved professionalism. These themes were incorporated into a consensus-based definition of medical professionalism, with a focus on anti-oppression, anti-racism, accountability, safety, and equity. Conclusions The authors propose a new definition of medical professionalism that embeds anti-oppression, including anti-racism, as critical competencies in clinical practice and education.

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