Department of Paediatrics, University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada.
Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
Med Educ. 2024 Dec;58(12):1442-1461. doi: 10.1111/medu.15425. Epub 2024 May 15.
Racialised trainees in Canada and the USA continue to disproportionately experience discrimination and harassment in learning environments despite equity, diversity, and inclusion (EDI) reform efforts. Using critical approaches to understand what problems have been conceptualised and operationalised as EDI issues within postgraduate medical education (PGME) is important to inform ongoing learning environment reform in resident training.
We conducted a critical narrative review of EDI literature from 2009-2022 using critical race theory (CRT) and the concept of intersectionality to analyse how issues of discrimination in PGME have been studied. Our search yielded 2244 articles that were narrowed down to 349 articles for relevance to Canadian and American PGME contexts. We attended to reflexivity and our positionality in analysing the database and identifying themes related to EDI reform.
Interest convergence was noted in how EDI reform was rationalised primarily by increased productivity. Problems of learner representation, gender inequities and curricular problems were conceptualised as EDI issues. The role that racism played in EDI-related problems was largely invisible, as were explicit conceptualisations of race and gender as social constructs. Overall, there was a lack of critical or intersectional approaches in the literature reviewed. Misalignment was noted where studies would frame a problem through a critical lens, but then study the problem without attention to power.
Interest convergence and epistemic injustice can account for the absence of critical approaches due to the alignment of existing EDI work with institutional interests and priorities. Interest convergence conceptually limits existing EDI reform efforts in PGME. CRT and intersectionality connect racialised learner experiences to systemic phenomena like racism and other forms of discrimination to challenge dominant assumptions. Because they attend to power, critical approaches are key to understanding why inequities have persisted to advance equity in learning environments for racialised and intersectionally marginalised learners.
尽管加拿大和美国在公平、多样性和包容性（EDI）改革方面做出了努力，但在学习环境中，仍有不成比例的少数族裔受训者经历歧视和骚扰。从批判的角度理解什么问题被概念化为和操作为研究生医学教育（PGME）中的 EDI 问题，对于告知住院医师培训中的学习环境改革是很重要的。
我们使用批判种族理论（CRT）和交叉性的概念，对 2009 年至 2022 年的 EDI 文献进行了批判性叙述性综述，以分析 PGME 中的歧视问题是如何被研究的。我们的搜索产生了 2244 篇文章，经过相关性筛选后，确定了 349 篇与加拿大和美国 PGME 背景相关的文章。我们关注了在分析数据库和确定与 EDI 改革相关的主题时的反思性和我们的立场。
我们注意到，EDI 改革的利益趋同主要是通过提高生产力来合理化的。学习者代表性问题、性别不平等和课程问题被概念化为 EDI 问题。种族主义在 EDI 相关问题中所起的作用在很大程度上是看不见的，种族和性别作为社会建构的明确概念化也是如此。总的来说，文献中缺乏批判性或交叉性的方法。在研究中，我们注意到存在一种不一致的情况，即一项研究通过批判的视角来构建一个问题，但随后在研究该问题时却没有关注权力。
利益趋同和认识论不公正可以解释批判性方法的缺失，因为现有的 EDI 工作与机构利益和优先事项一致。利益趋同在概念上限制了 PGME 中现有的 EDI 改革努力。CRT 和交叉性将少数族裔学习者的经历与系统性现象（如种族主义和其他形式的歧视）联系起来，以挑战主流假设。由于它们关注权力，批判性方法是理解为什么不平等现象持续存在的关键，以促进种族化和交叉边缘化学习者在学习环境中的公平。
