Harris Chelsea A, Vastardis Andrew, Jobin Chad, Dossett Lesly
Division of Plastic Surgery, University of Utah, Salt Lake City, UT.
University of Michigan, Ann Arbor, MI.
Ann Surg. 2025 Mar 1;281(3):430-437. doi: 10.1097/SLA.0000000000006604. Epub 2024 Dec 9.
To delineate how identity-based bias exposure evolves with rank and/or context among health care workers, and assess their attitudes toward existing diversity, equity, and inclusion (DEI) education.
Although DEI training is widely mandated for health care workers, few studies examine how clinicians' needs evolve across a career, how context impacts recipients' ability to respond, or how well existing programs adapt to individual contexts.
A 54-question electronic survey was distributed during Morbidity and Mortality conferences beginning in December 2020. Descriptive statistics were performed regarding respondents' bias exposure across rank, perceptions regarding existing training's fidelity to recipients' lived experience, and ability to confer useful response strategies.
This study included 648 individuals (65.6% White; 50.2% women) practicing in mostly academic medical centers (70.6%). Respondents affirmed that discrimination was common, with half (320, 49.4%) reporting that they experienced bias at least monthly. Among people of color, the proportion reporting monthly exposure decreased with rank. Women of color experienced the biggest drop (74% as residents/fellows down to 11% in late career). Broadly, participants reported the greatest discomfort in addressing subtle bias from patients or high-ranked individuals, and this did not uniformly improve with seniority. Finally, although 478 (73.8%) individuals reported receiving DEI training, 51.3% of respondents reported online DEI modules had little utility. Shortcomings included that training focused on individual rather than structural solutions and that it did not confer response strategies users could reliably employ.
Identity and context strongly influence both clinicians' exposure and ability to respond to bias in the hospital environment, independent of seniority. Existing DEI training fails to account for this nuance, ultimately diminishing its utility to clinicians.
描述基于身份的偏见暴露在医护人员中如何随职级和/或环境而演变，并评估他们对现有多元化、公平和包容（DEI）教育的态度。
尽管医护人员广泛接受DEI培训，但很少有研究探讨临床医生的需求如何在整个职业生涯中演变，环境如何影响接受者的应对能力，或者现有项目如何很好地适应个体情况。
2020年12月起在发病率与死亡率会议期间开展了一项包含54个问题的电子调查。对受访者在不同职级的偏见暴露、对现有培训与接受者实际生活经历契合度的看法以及提供有用应对策略的能力进行了描述性统计。
本研究纳入了648名个体（65.6%为白人；50.2%为女性），大多在学术医疗中心工作（70.6%）。受访者确认歧视很常见，一半（320人，49.4%）报告称他们至少每月经历一次偏见。在有色人种中，报告每月遭受偏见的比例随职级下降。有色人种女性下降幅度最大（住院医师/研究员阶段为74%，职业生涯后期降至11%）。总体而言，参与者表示在应对患者或高级别人员的微妙偏见时最感不适，且这种情况并不会随着资历的增加而一致改善。最后，尽管478人（73.8%）报告接受过DEI培训，但51.3%的受访者表示在线DEI模块效用不大。缺点包括培训侧重于个体而非结构性解决方案，且未提供用户可可靠采用的应对策略。
身份和环境强烈影响临床医生在医院环境中遭受偏见的情况以及应对偏见的能力，与资历无关。现有的DEI培训未能考虑到这一细微差别，最终降低了其对临床医生的效用。
