Upholding Our PROMISE

Purpose: Although Hispanic/Latinx, Black/African American, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander comprise 34% of the U.S. population, these racial and ethnic groups under-represented in medicine (UIM) account for only 7% of U.S. medical school faculty. Even when UIMs become faculty, they face many substantial challenges to success.1 Little has been published, however, on keys to academic success for URM young faculty investigators. Emerging studies are beginning to shed light on how discriminatory experiences can influence professional identity formation (PIF), one’s sense of belonging, and academic and professional career plans.2 To extend our understanding, the purpose of our quantitative research study was to explore associations between pediatric residents’ experiences with discrimination, burnout (interpersonal disengagement and work exhaustion), belonging, sense of professional fulfillment, and interest in (1) a career in academic medicine and (2) staying at their institution. Our overarching goal is to better support PIF in UIM trainees through better understanding the impact of experiences with discrimination in the clinical learning environment (CLE) and opportunities to improve well-being and retention in academic medicine. Method: From October 2020 to January 2021, we conducted an institutional review board-approved national, cross-sectional study: PROMISE (PROmoting Med-Ed Insight into Supportive Environments) to describe pediatric residents’ experiences and perspectives during training in relation to their self-identities. We used purposive sampling to distribute a 23-item web-based survey to pediatrics and med-peds residents through the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN). To obtain insight from pediatric residents about their past and current experiences in the CLE, we included components of the validated professional fulfillment scale instrument, and a regression model was constructed to explore changes in professional goals and career path plans during residency training.3 We assessed frequencies and means in descriptive analyses and associations using fixed effects regression models in adjusted analyses. Results: Twenty-nine residency programs; 931 total pediatric residents (19% UIM, 21% Asian, Asian American [AAA]); and more than 800 categorical pediatrics (20% UIM, 21% AAA) participated in the study. UIM and AAA residents were more likely to experience discrimination in the CLE when compared to White residents. Pediatric trainees who experienced racial discrimination by staff had increased interpersonal disengagement (P = .02), increased work exhaustion (P < .001), and decreased professional fulfillment (P = .0443). In adjusting for discriminatory experiences, UIM (P < .001) and AAA (P = .006) trainees still reported lower sense of belonging. Also of note, when controlling for initial interest in staying at institution, gender, and UIM status, residents who reported greater belonging also reported greater current interest in staying at their institution (β [confidence interval]: 0.46 [0.345–0.57]; P < .001). Discussion: UIM and AAA pediatric residents reported experiencing more racial discrimination and a lower sense of belonging during residency training. Programs that work to decrease incidents of racial discrimination and improve sense of belonging may enhance professional fulfillment for UIM and AAA residents and have more success in retaining UIM and AAA residents for fellowship and faculty positions at their home institutions. Further studies are needed to understand and address trainees’ unique experiences with discrimination and its influence on burnout, belonging, professional fulfillment, and academic career goals. Significance: This study introduces a specific need to assess and address resident experiences with discrimination to support resident sense of belonging and interest in academic careers. Findings highlight that UIM and AAA residents disproportionately experience discrimination from patients, faculty, peers, and staff, and further studies are needed to evaluate the influence of experiences with discrimination on the development and refinement of one’s professional identity during residency training

Disengagement theory · Ethnic group · Institution · Interpersonal communication · Medical education · Population · Professional development · Sociology · Adolescent and Pediatric Healthcare · Diversity and Career in Medicine · Healthcare professionals’ stress and burnout · Medicine · Psychology · Social Psychology · Gerontology