Hematology and oncology trainees frequently face discrimination, study shows
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Discriminatory behavior toward trainees in the hematology and oncology field remains common and appears to be displayed more often by patients than staff members, according to study results published in JAMA Network Open.
The findings highlighted a need for policies to protect individuals and development of faculty skills to address the discriminatory behavior, Rahma M. Warsame, MD, researcher in the division of hematology at Mayo Clinic, told Healio.
“My colleague, Katharine Price, MD, and I were tasked with addressing increasing challenges with our trainees who reported biased or discriminatory patient experiences. To support the trainees adequately, we found it critical to understand the root of the issues,” Warsame added. “We wanted to develop a policy built on their experiences and their insight as to what would be helpful. The development of a culture of transparency and a collective community of practice around exemplary diversity, equity and inclusion educational practices will promote innovation across Mayo Clinic.”
The qualitative study included 17 hematology and oncology fellows and recent graduates (median age, 32 years; 59% men) — six Asian, four white, three Hispanic, two Black and two multiracial individuals. Participants consented to telephone interviews conducted between July 2018 and November 2019 that gathered data on experiences of discrimination and inclusion to inform graduate medical education policies.
“We were surprised that 100% of our trainees experienced or witnessed biased or discriminatory behavior from patients,” Warsame said. “This behavior affected individuals who both experienced and witnessed it.”
Warsame said the researchers identified six major themes of discriminatory events participants experienced or witnessed, mostly from patients. The researchers interpreted the majority as microaggressions.
Themes included foreign fellows perceived as outsiders, U.S. citizens feeling alien at home, gender role typing, perception of futility of reporting, diversity and inclusion, and coping strategies.
“Both foreign-born and American citizens who did not meet preconceived notions based on their appearance of what an ‘American’ should look like experienced frequent discrimination from patients,” Warsame said.
Only one trainee reported incidents. Reasons for not reporting included difficulty characterizing discrimination and doubt that action would occur. However, participants stated that diversity of co-trainees, involvement in committees and open discussions promoted inclusivity.
“The diversity of our trainees breeds inclusion. Creating platforms for honest discussion and involvement in institutional practices creates a sense of belonging and feeling heard, and empowering trainees and staff to recognize and address this behavior is for the betterment of everyone,” Warsame said. “These experiences will occur, but having policies to protect individuals and developing faculty skills to address it is essential. Creating a more diverse staff and trainees improves a sense of belonging for everybody, and understanding the issues within each institution, department and division is a critical first step to help to create informed solutions.”
The study has prompted communication workshops and faculty development to better equip trainees with strategies to address patients who behave or display disrespectful or discriminatory behavior, Warsame added.
“In addition, to empower trainees to report any incidents, Mayo Clinic School of Graduate Medical Education has increased awareness among trainees on Mayo Clinic’s policy to protect all health care staff against patient misconduct,” she said. “We would love to pursue additional programs to get a better understanding of what our trainees in other specialties are experiencing to create schoolwide policies and practices to support all trainees.”
For more information:
Rahma M. Warsame, MD, can be reached at Mayo Clinic, 200 First St. SW, Rochester, MN 55905; email: warsame.rahma@mayo.edu.
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