Does it work? Resident selection and implicit bias training for postgraduate program directors.

One element to address health disparities and historical injustices of systemically excluded groups is to examine selection processes. Implicit association testing for selection committees is suggested as one intervention to address bias in selection and is used for Undergraduate Medical Education at the University of Manitoba. Our study demonstrated that implicit bias training for PDs in isolation has minimal impact on addressing bias within resident selection. This training must occur as part of a systemic institutional approach to address bias in resident selection. Programs should consider a multipronged and sustained approach when committing to diversifying postgraduate medical education programs.

Le processus de sélection est un des éléments à revoir pour lutter contre les inégalités en matière de santé et les injustices historiques dont souffrent les populations victimes d'exclusion systémique. Une des mesures suggérées pour contrer le biais de sélection est de soumettre les membres des comités de sélection à des tests d'association implicite. Ils sont utilisés à l'Université du Manitoba au programme d'études médicales de premier cycle. Or, notre étude montre qu'une formation en matière de biais implicites, lorsqu'elle est offerte de manière isolée aux directeurs de programme, a peu d'impact sur l'élimination des préjugés dans la sélection des résidents. Les programmes qui désirent favoriser la diversité doivent envisager une approche multidimensionnelle et soutenue.

Sociodemographic Variables in Canadian Organ Donation Organizations: A Health Information Survey.

Health systems must collect equity-relevant sociodemographic variables to measure and mitigate health inequities. The specific variables collected by organ donation organizations (ODOs) across Canada, variable definitions, and processes of the collection are not defined. We undertook a national health information survey of all ODOs in Canada. These results will inform the development of a standard national dataset of equity-relevant sociodemographic variables. Methods: We conducted an electronic, self-administered cross-sectional survey of all ODOs in Canada from November 2021 to January 2022. We targeted key knowledge holders familiar with the data collection processes within each Canadian ODO known to Canadian Blood Services. Categorical item responses are presented as numbers and proportions. Results: We achieved a 100% response rate from 10 Canadian ODOs. Most data were collected by organ donation coordinators. Only 2 of 10 ODOs reported using scripts explaining why sociodemographic data are being collected or incorporated training in cultural sensitivity for any given variable. A lack of cultural sensitivity training was endorsed by 50% of respondents as a barrier to the collection of sociodemographic variables by ODOs, whereas 40% of respondents identified a lack of training in sociodemographic variable collection as a significant barrier. Conclusions: Few programs routinely collect sufficient data to examine health inequities with an intersectional lens. Most data collection occurs midway through the ODO interaction, creating a missed opportunity to better understand differences in social identities of patients who register their intention to donate in advance or who decline the donation. National standardization of equity-relevant data collection definitions and processes of the collection is needed.

Inequities in organ and tissue donation and transplantation for sexual orientation and gender identity diverse people: A scoping review.

Sexual orientation and gender identity (SOGI)-diverse populations experience discrimination in organ and tissue donation and transplantation (OTDT) systems globally. We assembled a multidisciplinary group of clinical experts as well as SOGI-diverse patient and public partners and conducted a scoping review including citations on the experiences of SOGI-diverse persons in OTDT systems globally to identify and explore the inequities that exist with regards to living and deceased OTDT. Using scoping review methods, we conducted a systematic literature search of relevant electronic databases from 1970 to 2021 including a grey literature search. We identified and screened 2402 references and included 87 unique publications. Two researchers independently coded data in included publications in duplicate. We conducted a best-fit framework synthesis paired with an inductive thematic analysis to identify synthesized benefits, harms, inequities, justification of inequities, recommendations to mitigate inequities, laws and regulations, as well as knowledge and implementation gaps regarding SOGI-diverse identities in OTDT systems. We identified numerous harms and inequities for SOGI-diverse populations in OTDT systems. There were no published benefits of SOGI-diverse identities in OTDT systems. We summarized recommendations for the promotion of equity for SOGI-diverse populations and identified gaps that can serve as targets for action moving forward.

Equity-relevant sociodemographic variable collection in emergency medicine: A systematic review, qualitative evidence synthesis, and recommendations for practice.

OBJECTIVES: The objective was to conduct a systematic review and qualitative evidence synthesis (QES) to identify best practices, benefits, harms, facilitators, and barriers to the routine collection of sociodemographic variables in emergency departments (EDs). METHODS: This work is a systematic review and QES. We conducted a comprehensive search of Medline (Ovid), CINAHL (Ebsco), Cochrane Central (OVID), EMBASE (Ovid), and the multidisciplinary Web of Science Core database using peer-reviewed search strategies, complemented by a gray literature search. We included citations containing perspectives on routine sociodemographic variable collection in EDs and recommendations on definitions or processes of collection or benefits, harms, facilitators, or barriers related to the routine collection of sociodemographic variables in EDs. We conducted this systematic review and QES adhering to the Joanna Briggs Institute guidelines. Two reviewers independently selected included studies and extracted data. We conducted a best-fit framework synthesis and paired inductive thematic analysis of the included studies. We generated recommendations based on the QES. RESULTS: We included 21 unique reports that enrolled 10,454 patients or respondents in our systematic review and QES. Publication dates of included studies ranged from 2011 to 2021. Included citations were published in Australia, Canada, and the United States. We synthesized 11 benefits, 14 potential harms, 15 barriers, and 19 facilitators and identified 14 best practice recommendations from included citations. CONCLUSIONS: Health systems should routinely collect sociodemographic variables in EDs guided by recommendations that minimize harms and maximize benefits and consider relevant barriers and facilitators. Our recommendations can serve as a guide for the equity-focused reformation of emergency medicine health information systems.

Burden of Allergic Disease in Racial and Ethnic Structurally Oppressed Communities Within Canada and the United States: A Scoping Review.

BACKGROUND: The social determinants of health have been extensively studied as potential mediating variables in the development and/or progression of many chronic illnesses, including allergic diseases, and may contribute to social inequities as barriers in accessing health care. OBJECTIVE: We aimed to perform a scoping literature review to describe the burden of disease and access to health care for treatment of allergic disease within literature specific to structurally oppressed racial and ethnic populations. METHODS: We performed a scoping review, guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Scoping Reviews, of 3 scientific databases and 5 relevant gray literature sites. Search strategy including keywords describing race and ethnicity were selected based on the acceptable nomenclature in Canada and the United States. We imposed no restrictions on date or country of publication, study design, or age of participants. RESULTS: Our literature search yielded 1,198 potentially relevant articles following deduplication. After title and abstract, and subsequently full-text screening, a total of 12 (1.08% of all articles) were included. These 12 included studies pointed toward a higher burden of allergic and atopic disease, including increased presentations to emergency departments, hospitalizations, mortality, younger age of diagnosis, and/or greater severity of disease, among Black or African American individuals, than the general population. Allergies beyond the top 9 food allergens, eosinophilic esophagitis, and asthma appeared to be more prevalent and more severe in this population than in the general population. There appears to be an increased burden of allergic and atopic disease among the Indigenous Peoples of Canada, whereas this was not noted for Latinx or Hispanic populations, in part due to a paucity of studies involving these populations. Owing to a lack of published literature, no conclusions could be drawn regarding allergy and atopy in Native American populations. CONCLUSIONS: Structurally oppressed racial and ethnic communities may face an increased burden of allergic and atopic disease-but that this may be magnified by issues regarding oppression, access, and social environment that warrant further investigation.

Paying the price? Academic work and parenting during COVID-19.

Introduction: The shift to remote working/learning to slow transmission of the SARS-CoV-2 virus has had widespread mental health impacts. We aimed to describe how the COVID-19 pandemic impacted the mental health of students and faculty within a health sciences faculty at a central Canadian university. Methods: Via an online survey, we queried mental health in the first four months of the COVID-19 pandemic quantitatively (scale: 1 (most negative)-100 (most positive)) and qualitatively. Results: The sample (n = 110) was predominantly women (faculty 39/59; [66.1%]; students 46/50; [92.0%]). Most faculty were married/common law (50/60; [84.8%]) and had children at home (36/60; [60.0%]); the opposite was true for most students.Faculty and students self-reported comparable mental health (40.47±24.26 and 37.62±26.13; respectively). Amongst women, those with vs. without children at home, reported significantly worse mental health impacts (31.78±23.68 vs. 44.29±27.98; respectively, p = 0.032).Qualitative themes included: "Sharing resources," "spending money," "few changes," for those without children at home; "working at home can be isolating," including the subtheme, "balancing act": "working in isolation," "working more," for those with children at home. Discussion: Amongst women in academia, including both students and faculty, those with children at home have disproportionately worse mental health than those without children at home.

Introduction: Le virage vers le travail et l'enseignement à distance pour ralentir la transmission du virus SRAS-CoV-2 a eu des répercussions étendues sur la santé mentale. Notre étude vise à décrie l'impact de la pandémie de la COVID-19 sur la santé mentale des étudiants et du corps professoral au sein Faculté des sciences de la santé d'une université du centre du Canada. Méthodes: Un questionnaire en ligne a été administré pour récolter des données qualitatives et quantitatives (échelle : de 1 [le plus négatif] à 100 [le plus positif] à l'égard de la santé mentale des participants au cours des quatre premiers mois de la pandémie. Résultats: L'échantillonnage (n = 110) était majoritairement composé de femmes (membres du corps professoral : 39/59 ou 66,1 %; étudiantes 46/50 ou 92,0 %). La plupart des répondants du corps professoral étaient mariés ou en union libre (50/60 ou 84,8 %) et avaient des enfants à la maison (36/60 ou 60,0 %). Le contraire était vrai pour la plupart des étudiants. L'état de santé mentale déclaré par le corps professoral et les étudiants était comparable (40,47±24,26 et 37,62±26,13 respectivement). Parmi les femmes, autant celles qui avaient des enfants à la maison que celles qui n'en avaient pas, ont déclaré que leur santé mentale était nettement moins bonne (31,78±23,68 contre 44,29±27,98 respectivement; p = 0,032).Pendant l'analyse des données qualitatives, on a identifié les thèmes « le partage de ressources ¼, « les dépenses ¼ et « peu de changements ¼ pour les répondants qui n'avaient pas d'enfants à la maison alors que les thème « le télétravail accentue l'isolement ¼, ainsi que lessous-thèmes « maintien de l'équilibre : travailler en isolement'' et ''travailler plus ¼ ont émergé pour ceux qui avaient des enfants à la maison. Discussion: Parmi les femmes œuvrant dans le milieu universitaire, qu'elles soient étudiantes ou membres du corps professoral, la santé mentale de celles qui ont des enfants à la maison est davantage affectée que celle des femmes qui n'en ont pas.