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Associations Of Discrimination And Stress In Medical Education Learners

Purpose: The objective of this study was to investigate the association between perceptions of discrimination, self-identified burnout, with microaggressions and stress in a cohort of medical education learners.


Background:  Discrimination and microaggressions occur within the health professions institution, and their negative impacts are pervasive in the health professions learning environment. These forces impair the ability to take care of patients, recruit, and support diverse health care providers, and prepare the next generation of clinicians for practice.


Methods: This was a prospective educational study. Medical students, pipeline students and interns completed the Brief Perceived Ethnic Discrimination Questionnaire-Community Version (a 17-item validated item) survey and Perceived Stress Scale (a 10-item validated item) survey, demographics, burn-out and institutional wellness resource questions. Statistical analysis performed as indicated using chi square, student t test and ANOVA as indicated. P value of< 0.05 was significant.


Results: A total of 248 learners participated including 29% underrepresented in medicine (UiM) (African American, Hispanic, Native American, Pacific islander) learners and 71% non-UiM learners (Non-Hispanic Whites and Asians). Low stress was perceived in 33%; moderate stress in 57% and high stress in 10%. Complete burnout occurred in 2% and definitely burning-out by 20%. Lifetime exposure to discrimination perceived to happen very often by 22% of learners. There was a significantly positive association between stress and lifetime discrimination (low stress=12%, moderate stress=23%, high stress=47%, p=0.001). Alternatively, there were significantly inverse associations between stress and backup support by supervisors (low stress=67%, moderate stress=60%, high stress=22%, p=0.003) and institutional support for wellbeing (low stress=72%, moderate stress=72%, high stress=32%, p=0.002). Burnout participants compared to participants who were not burned out were also significantly associated with lifetime exposure to discrimination (40% versus 12%, p=0.001), total stress score (23.9 versus 15.1, p=0.001) and perceived microaggressions as a source of anxiety and stress (80% versus 28%, p=0.001). There were no direct significant associations between race and stress or burnout.      

Discussions: Perceptions of discrimination and microaggressions were significantly associated with stress and burnout. The lack of association between race and stress in this cohort support the framework that racism and not race is the risk factor.

Topics: CREOG & APGO Annual Meeting, 2023, Student, Resident, Faculty, Clerkship Director, Clerkship Coordinator, Osteopathic Faculty, Residency Director, Residency Coordinator, Professionalism, Interpersonal & Communication Skills, GME, UME, Advocacy,

General Information

Student,Resident,Faculty,Clerkship Director,Clerkship Coordinator,Osteopathic Faculty,Residency Director,Residency Coordinator,
Professionalism,Interpersonal & Communication Skills,
Clinical Focus

Author Information

Dotun Ogunyemi, MD; Arrowhead Regional Medical Center; Jasmaine Coleman, DO; Carolyne Njeri Kuria, MD; Abhinav Markus, MD, MS; Caleb Ting, Medical Student; Amir Teixeira, BS, MBS, MPH

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