Medical students with multiple identities considered historically marginalized are more likely to report mistreatment and discrimination during their schooling, according to a new US study.

New findings from a team of Yale University investigators suggest that students who identified as female, non-white, lesbian, gay or bisexual, or any combination thereof, were significantly more likely to report recurrent experiences of abuse and discrimination, as well as higher burnout scores. The team expressed concern that these factors contribute to a disparate rate of burnout among diverse populations of aspiring clinicians.

Led by Bethlehem G. Teshome, MPH, postgraduate associate and evaluation specialist in the Department of Social and Behavioral Sciences at the Yale School of Public Health, the investigators sought to describe the link between abuse, discrimination, burnout and multiple marginalized identities among American undergraduates. medical students.

Their cross-sectional survey and retrospective cohort evaluation included 30,651 students graduating from 140 accredited U.S. medical schools in 2016 and 2017. Participants completed the annual medical school graduation questionnaire—designed to assess curricula and medical school experiences – at the time of their graduation.

Teshome and colleagues included sociodemographic variables in the assessment, including self-reported gender (male or female), sexual orientation, race and ethnicity. Race or ethnicity was dichotomized as white or non-white, with categories for the latter including Asian, Black, Hispanic, American Indian, Alaskan Native, Hawaiian, Pacific Islanders, multiracial or otherwise.

Specifically for sexual orientation, participants were divided into heterosexual or lesbian, gay or bisexual.

Intersectional analysis was used to examine the simultaneous effect of multiple marginalized identities in 1 medical student, featuring the 8 possible unique identity combinations from the 3 sociodemographic variables of gender, sexual orientation, and race or of ethnic origin. “These single-identity clusters provide a more granular and nuanced picture of mistreatment, discrimination, and symptoms of burnout reported by students of diverse identities,” the investigators explained.

Measures of abuse and discrimination were assessed using several items from the graduation questionnaire regarding students’ experiences of negative behaviors. Burnout was assessed by the Oldenburg Burnout Inventory for Medical Students, including burnout subscales.

Less than half (48.5%) of all respondents identified as female; 39.2% identified as non-white and 5.5% stated their sexual orientation as lesbian, gay or bisexual.

Overall, 46.0% of all students surveyed reported experiencing abuse. Another 9.5% reported recurrent experiences of multiple types of abuse. Male (59.1%) and heterosexual (54.9%) students were more likely to report no experience of abuse than females (48.5%; P <.001 and lesbian gay or bisexual students>P <.001>

Of the 299 students to identify as 3 marginalized identities (female, non-white and lesbian, gay or bisexual), 88 reported recurring experiences of abuse (P <.001 others reported multiple forms of discrimination>P <.001>

These participants were proportionally the students most affected by the assessment. They were also more likely to report higher mean burnout scores after graduating from medical school, reported an adjusted mean difference of 1.96 (95% CI, 1.47, 2.44) compared to scores of heterosexual white male students.

Teshome and her colleagues noted that previous research indeed showed that non-white, non-heterosexual female medical students experienced more abuse and discrimination during their undergraduate studies. Their contribution to such analyzes shows such problems with national data.

Additionally, the new findings show a “significant association” between multiple marginalized identities and burnout among medical students.

“The higher burnout scores among historically marginalized students are consistent with previous non-intersectional studies that use minority tax and racial fatigue frameworks to describe the experiences of medical trainees and faculty of racial or ethnic minorities,” they wrote. “The additional pressure that marginalized groups face to represent their communities or contribute to diversity efforts in their institutions and experiences of bias and discrimination likely contribute to the observed effect with this dimension of burnout.”

Investigators have called for better integration of support services, as well as groups of students with marginalized identities, both into medical education and into each other. “Increased interaction between groups that focus on a singular aspect of identity could provide a structure of support for students with multiple marginalized identities,” they wrote.

Additionally, ongoing efforts to build medical school faculty diversity should be pursued, along with institutional support systems for groups predisposed to more severe burnout and disengagement scores, such as lesbian students, gays and bisexuals.

“Furthermore, the fact that students with multiple marginalized identities reported greater exposure to recurrent mistreatment and discrimination points to the need for leaders in academic medicine to improve existing mechanisms to address reports of negative behaviors. and create a climate of respect,” they concluded.

The study, “Marginalized identities, abuse, discrimination, and burnout among American medical students: cross-sectional survey and retrospective cohort studywas published online in The BMJ.