Assessing the need for Black mentorship within residency training in Canada.

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From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 42)
Publisher: CMA Impact Inc.
Document Type: Viewpoint essay
Length: 3,533 words
Lexile Measure: 1920L

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Black medical learners often experience racial prejudice, microaggressions, isolation and biased assessments during their medical training. Furthermore, rates of recruitment, retention and promotion are lower among Black learners and faculty. Formal equity, diversity and inclusive programs, including culturally appropriate mentorship, are necessary to mitigate the layered disadvantages faced by Black learners that precede admission to medical school. As the number of Black medical students is slowly increasing, it is important to connect Black learners with Black mentors who can provide support through their shared lived experiences. However, the underrepresentation of Black physicians in Canada limits the number of Black physicians available to provide racially concordant mentorship. To date, mentorship programs for Black undergraduate students and medical students exist across Canada, but mentorship for Black residents by Black physicians is lacking. We consider the challenges and the need for mentorship among Black residents in Canada and highlight the implementation of a national racially concordant mentorship program for Black residents, fellows and early career physicians.

What factors affect the experiences of Black medical learners in Canada?

Multiple factors contribute to the experiences of Black learners in medicine. Internalized and systemic racism may lower self-efficacy and confidence during the application to medical school. (1) External barriers include a lack of mentors, finances and noninclusive admissions processes. (1) Black medical learners experience a diminished sense of belonging, differing expectations and feeling othered, resulting in a lack of retention in their programs. (2) A disproportionately higher rate of attrition during residency has been documented. (3) In the United States, about 20% of residents dismissed from their programs in 2015 were Black, despite Black residents making up only 5% of the resident population. (4)

Data from the University of Toronto showed that in 2020, 56% of Black medical students, 66% of Black residents and 39% of Black fellows experienced discrimination at least once within the past year. (5) This is likely rooted in anti-Black racism and institutional policies and practices that promote biased admission processes, microaggressions, discrimination and differential treatment from supervisors, peers and patients. (2,6,7) A cross-sectional survey among general surgery residents in Canada found that residents who were visible minorities reported being perceived as less competent owing to their race, compared with nonvisible minorities. (8) Black trainees may also experience emotional abuse, gaslighting and unfavourable evaluations. (9) These barriers persist into independent practice and affect career progression, compensation and stressors faced by Black physicians as documented in a literature review from the United Kingdom. (10)

The barriers and experiences outlined previously ultimately result in the underrepresentation of people identifying as Black within medicine. In Ontario, Black physicians make up about 2.3% of practising physicians in the province, compared with 4.7% of the Black population. (11) Although limited race-based data collected by medical schools in Canada are available, a recent survey across English-speaking medical schools estimated the proportion of Black medical students to be 1.7% compared with 6.4% of the Black population in Canada. (12) To our knowledge, few Canadian residency programs collect race-based data,...

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Gale Document Number: GALE|A724594742