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Journal of General Internal Medicine Apr 2020Impostor syndrome is increasingly presented in the media and lay literature as a key behavioral health condition impairing professional performance and contributing to... (Review)
Review
BACKGROUND
Impostor syndrome is increasingly presented in the media and lay literature as a key behavioral health condition impairing professional performance and contributing to burnout. However, there is no published review of the evidence to guide the diagnosis or treatment of patients presenting with impostor syndrome.
PURPOSE
To evaluate the evidence on the prevalence, predictors, comorbidities, and treatment of impostor syndrome.
DATA SOURCES
Medline, Embase, and PsycINFO (January 1966 to May 2018) and bibliographies of retrieved articles.
STUDY SELECTION
English-language reports of evaluations of the prevalence, predictors, comorbidities, or treatment of impostor syndrome.
DATA EXTRACTION
Two independent investigators extracted data on study variables (e.g., study methodology, treatments provided); participant variables (e.g., demographics, professional setting); diagnostic tools used, outcome variables (e.g., workplace performance, reductions in comorbid conditions); and pre-defined quality variables (e.g., human subjects approval, response rates reported).
DATA SYNTHESIS
In total, 62 studies of 14,161 participants met the inclusion criteria (half were published in the past 6 years). Prevalence rates of impostor syndrome varied widely from 9 to 82% largely depending on the screening tool and cutoff used to assess symptoms and were particularly high among ethnic minority groups. Impostor syndrome was common among both men and women and across a range of age groups (adolescents to late-stage professionals). Impostor syndrome is often comorbid with depression and anxiety and is associated with impaired job performance, job satisfaction, and burnout among various employee populations including clinicians. No published studies evaluated treatments for this condition.
LIMITATIONS
Studies were heterogeneous; publication bias may be present.
CONCLUSIONS
Clinicians and employers should be mindful of the prevalence of impostor syndrome among professional populations and take steps to assess for impostor feelings and common comorbidities. Future research should include evaluations of treatments to mitigate impostor symptoms and its common comorbidities.
Topics: Adolescent; Burnout, Professional; Ethnicity; Female; Humans; Job Satisfaction; Male; Minority Groups; Prevalence
PubMed: 31848865
DOI: 10.1007/s11606-019-05364-1 -
JAMA Surgery May 2021Workplace mistreatment can manifest as microaggressions that cause chronic, severe distress. As physician burnout becomes a global crisis, quantitative research to...
IMPORTANCE
Workplace mistreatment can manifest as microaggressions that cause chronic, severe distress. As physician burnout becomes a global crisis, quantitative research to delineate the impact of microaggressions is imperative.
OBJECTIVES
To examine the prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic-minority surgeons and anesthesiologists and assess the association with physician burnout.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional survey evaluated microaggressions and physician burnout within a diverse cohort of surgeons and anesthesiologists in a large health maintenance organization. A total of 1643 eligible participants were sent a recruitment email on January 8, 2020, 1609 received the email, and 652 replied, for a response rate of 41%. The study survey remained open until February 20, 2020. A total of 588 individuals (37%) were included in the study after exclusion criteria were applied.
EXPOSURES
The Maslach Burnout Inventory, the Racial Microaggression Scale, and the Sexist Microaggression Experience and Stress Scale.
MAIN OUTCOMES AND MEASURES
The primary outcomes were prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic-minority surgeons and anesthesiologists using the Sexist Microaggression Experience and Stress Scale and Racial Microaggression Scale. Secondary outcomes were frequency and severity of microaggressions, prevalence of physician burnout, and associations between microaggressions and physician burnout.
RESULTS
Data obtained from 588 respondents (249 [44%] female, 367 [62%] racial/ethnic minority, 224 [38.1%] 40-49 years of age) were analyzed. A total of 245 of 259 female respondents (94%) experienced sexist microaggressions, most commonly overhearing or seeing degrading female terms or images. Racial/ethnic microaggressions were experienced by 299 of 367 racial/ethnic-minority physicians (81%), most commonly reporting few leaders or coworkers of the same race/ethnicity. Criminality was rare (18 of 367 [5%]) but unique to and significantly higher for Hispanic and Black physicians. Individuals who identified as underrepresented minorities were more likely to experience environmental inequities (odds ratio [OR], 4.21; 95% CI, 1.6-10.75; P = .002) and criminality (OR, 14.93; 95% CI, 4.5-48.5; P < .001). The prevalence of physician burnout was 47% (280 of 588 physicians) and higher among female physicians (OR, 1.60; 95% CI, 1.03-2.47; P = .04) and racial/ethnic-minority physicians (OR, 2.08; 95% CI, 1.31-3.30; P = .002). Female physicians who experienced sexist microaggressions (racial/ethnic-minority female physicians: OR, 1.84; 95% CI, 1.04-3.25; P = .04; White female physicians: OR, 1.99; 95% CI, 1.07-3.69; P = .03) were more likely to experience burnout. Racial/ethnic-minority female physicians (OR, 1.86; 95% CI, 1.03-3.35; P = .04) who experienced racial microaggressions were more likely to report burnout. Racial/ethnic-minority female physicians who had the compound experience of sexist and racial/ethnic microaggressions (OR, 2.05; 95% CI, 1.14-3.69; P = .02) were more likely to experience burnout.
CONCLUSIONS AND RELEVANCE
The prevalence of sexist and racial/ethnic microaggressions against female and racial/ethnic-minority surgeons and anesthesiologists was high and associated with physician burnout. This study provides a valuable response to the increasing call for evidence-based data on surgical workplace mistreatment.
Topics: Adult; Black or African American; Anesthesiologists; Burnout, Professional; Cross-Sectional Studies; Ethnicity; Female; Hispanic or Latino; Humans; Incivility; Male; Microaggression; Middle Aged; Minority Groups; Native Hawaiian or Other Pacific Islander; Physicians, Women; Prevalence; Race Factors; Racism; Sex Factors; Sexism; Surgeons; White People; Young Adult
PubMed: 33760000
DOI: 10.1001/jamasurg.2021.0265 -
Nature Jul 2023Human genomics is witnessing an ongoing paradigm shift from a single reference sequence to a pangenome form, but populations of Asian ancestry are underrepresented. Here...
Human genomics is witnessing an ongoing paradigm shift from a single reference sequence to a pangenome form, but populations of Asian ancestry are underrepresented. Here we present data from the first phase of the Chinese Pangenome Consortium, including a collection of 116 high-quality and haplotype-phased de novo assemblies based on 58 core samples representing 36 minority Chinese ethnic groups. With an average 30.65× high-fidelity long-read sequence coverage, an average contiguity N50 of more than 35.63 megabases and an average total size of 3.01 gigabases, the CPC core assemblies add 189 million base pairs of euchromatic polymorphic sequences and 1,367 protein-coding gene duplications to GRCh38. We identified 15.9 million small variants and 78,072 structural variants, of which 5.9 million small variants and 34,223 structural variants were not reported in a recently released pangenome reference. The Chinese Pangenome Consortium data demonstrate a remarkable increase in the discovery of novel and missing sequences when individuals are included from underrepresented minority ethnic groups. The missing reference sequences were enriched with archaic-derived alleles and genes that confer essential functions related to keratinization, response to ultraviolet radiation, DNA repair, immunological responses and lifespan, implying great potential for shedding new light on human evolution and recovering missing heritability in complex disease mapping.
Topics: Humans; East Asian People; Ethnicity; Genome, Human; Sequence Analysis, DNA; Ultraviolet Rays; Human Genetics; Minority Groups; Ethnic and Racial Minorities; Reference Standards; Haplotypes; Euchromatin; Genetic Variation; Alleles; DNA Repair; Keratins; Longevity; Immunity
PubMed: 37316654
DOI: 10.1038/s41586-023-06173-7 -
Lancet (London, England) Mar 2021The HIV epidemic in the USA began as a bicoastal epidemic focused in large cities but, over nearly four decades, the epidemiology of HIV has changed. Public health... (Review)
Review
The HIV epidemic in the USA began as a bicoastal epidemic focused in large cities but, over nearly four decades, the epidemiology of HIV has changed. Public health surveillance data can inform an understanding of the evolution of the HIV epidemic in terms of the populations and geographical areas most affected. We analysed publicly available HIV surveillance data and census data to describe: current HIV prevalence and new HIV diagnoses by region, race or ethnicity, and age; trends in HIV diagnoses over time by HIV acquisition risk and age; and the distribution of HIV prevalence by geographical area. We reviewed published literature to explore the reasons for the current distribution of HIV cases and important disparities in HIV prevalence. We identified opportunities to improve public health surveillance systems and uses of data for planning and monitoring public health responses. The current US HIV epidemic is marked by geographical concentration in the US South and profound disparities between regions and by race or ethnicity. Rural areas vary in HIV prevalence; rural areas in the South are more likely to have a high HIV prevalence than rural areas in other US Census regions. Ongoing disparities in HIV in the South are probably driven by the restricted expansion of Medicaid, health-care provider shortages, low health literacy, and HIV stigma. HIV diagnoses overall declined in 2009-18, but HIV diagnoses among individuals aged 25-34 years increased during the same period. HIV diagnoses decreased for all risk groups in 2009-18; among men who have sex with men (MSM), new diagnoses decreased overall and for White MSM, remained stable for Black MSM, and increased for Hispanic or Latino MSM. Surveillance data indicate profound and ongoing disparities in HIV cases, with disproportionate impact among people in the South, racial or ethnic minorities, and MSM.
Topics: Adolescent; Adult; Cost of Illness; Ethnicity; Female; HIV Infections; Health Literacy; Health Personnel; Healthcare Disparities; Homosexuality, Male; Humans; Male; Medicaid; Middle Aged; Minority Groups; Prevalence; Public Health Surveillance; Sexual and Gender Minorities; Social Stigma; United States; Young Adult
PubMed: 33617774
DOI: 10.1016/S0140-6736(21)00395-0 -
Annals of Surgery Sep 2022To evaluate if patient-derived organoids (PDOs) may predict response to neoadjuvant (NAT) chemotherapy in patients with pancreatic adenocarcinoma.
OBJECTIVE
To evaluate if patient-derived organoids (PDOs) may predict response to neoadjuvant (NAT) chemotherapy in patients with pancreatic adenocarcinoma.
BACKGROUND
PDOs have been explored as a biomarker of therapy response and for personalized therapeutics in patients with pancreatic cancer.
METHODS
During 2017-2021, patients were enrolled into an IRB-approved protocol and PDO cultures were established. PDOs of interest were analyzed through a translational pipeline incorporating molecular profiling and drug sensitivity testing.
RESULTS
One hundred thirty-six samples, including both surgical resections and fine needle aspiration/biopsy from 117 patients with pancreatic cancer were collected. This biobank included diversity in stage, sex, age, and race, with minority populations representing 1/3 of collected cases (16% Black, 9% Asian, 7% Hispanic/Latino). Among surgical specimens, PDO generation was successful in 71% (15 of 21) of patients who had received NAT prior to sample collection and in 76% (39 of 51) of patients who were untreated with chemotherapy or radiation at the time of collection. Pathological response to NAT correlated with PDO chemotherapy response, particularly oxaliplatin. We demonstrated the feasibility of a rapid PDO drug screen and generated data within 7 days of tissue resection.
CONCLUSION
Herein we report a large single-institution organoid biobank, including ethnic minority samples. The ability to establish PDOs from chemotherapy-naive and post-NAT tissue enables longitudinal PDO generation to assess dynamic chemotherapy sensitivity profiling. PDOs can be rapidly screened and further development of rapid screening may aid in the initial stratification of patients to the most active NAT regimen.
Topics: Adenocarcinoma; Antineoplastic Agents; Ethnicity; Humans; Minority Groups; Neoadjuvant Therapy; Organoids; Pancreatic Neoplasms
PubMed: 35972511
DOI: 10.1097/SLA.0000000000005558 -
The Journal of Applied Psychology Jan 2021It is impossible to write this editorial without recognizing that we are living in challenging times. Unprecedented changes in how, when, where, and with whom we work...
It is impossible to write this editorial without recognizing that we are living in challenging times. Unprecedented changes in how, when, where, and with whom we work have occurred in response to the COVID-19 pandemic. In addition to the threat to human life, the pandemic is expected to increase poverty and deepen preexisting inequalities for vulnerable groups such as women (United Nations, 2020) and individuals living in poorer countries (United Nations Development Programme, 2020). In the United States, the pandemic has disproportionately negatively affected racial and ethnic minority group members (https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html). For example, in the United States infection and mortality rates are especially high among African Americans (Yancy, 2020). These sobering realities, along with the recent deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor, and so many others, are vivid and wrenching reminders of longstanding social injustice and systematic racism, both in the United States and around the globe. When preparing my candidate statement and vision for the journal, a global pandemic and widespread social protest were the furthest thing from my mind. However, several aspects of my vision for are highly relevant to the current context. This includes increasing representation and supporting diversity, as well as improving the translation of our science for the public good. Other elements of my vision for the journal include enhancing the review process and promoting open science. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: COVID-19; Ethnicity; Humans; Minority Groups; Pandemics; Poverty; Psychology, Applied; Racism; SARS-CoV-2; Social Justice; Socioeconomic Factors; United States
PubMed: 33444047
DOI: 10.1037/apl0000862 -
BMJ Open Ophthalmology Feb 2023In ophthalmology, clinical trials (CTs) guide the treatment of diseases such as diabetic retinopathy, myopia, age-related macular degeneration, glaucoma and keratoconus... (Review)
Review
INTRODUCTION
In ophthalmology, clinical trials (CTs) guide the treatment of diseases such as diabetic retinopathy, myopia, age-related macular degeneration, glaucoma and keratoconus with distinct presentations, pathological characteristics and responses to treatment in minority populations.Reporting gender and race and ethnicity in healthcare studies is currently recommended by National Institutes of Health (NIH) and Food and Drug Administration (FDA) guidelines to ensure representativeness and generalisability; however, CT results that include this information have been limited in the past 30 years.The objective of this review is to analyse the sociodemographic disparities in ophthalmological phases III and IV CT based on publicly available data.
METHODS
This study included phases III and IV complete ophthalmological CT available from clinicaltrials.org, and describes the country distribution, race and ethnicity description and gender, and funding characteristics.
RESULTS
After a screening process, we included 654 CTs, with findings that corroborate the previous CT reviews' findings that most ophthalmological participants are white and from high-income countries. A description of race and ethnicity is reported in 37.1% of studies but less frequently included within the most studied ophthalmological specialty area (cornea, retina, glaucoma and cataracts). The incidence of race and ethnicity reporting has improved during the past 7 years.
DISCUSSION
Although NIH and FDA promote guidelines to improve generalisability in healthcare studies, the inclusion of race and ethnicity in publications and diverse participants in ophthalmological CT is still limited. Actions from the research community and related stakeholders are necessary to increase representativeness and guarantee generalisability in ophthalmological research results to optimise care and reduce related healthcare disparities.
Topics: United States; Humans; Ophthalmology; Ethnicity; Minority Groups; Cataract; Glaucoma
PubMed: 37278426
DOI: 10.1136/bmjophth-2022-001175 -
CBE Life Sciences Education Jun 2022Science, technology, engineering, and mathematics (STEM) career barriers persist for individuals from marginalized communities due to financial and educational...
Science, technology, engineering, and mathematics (STEM) career barriers persist for individuals from marginalized communities due to financial and educational inequality, unconscious bias, and other disadvantaging factors. To evaluate differences in plans and interests between historically underrepresented (UR) and well-represented (WR) groups, we surveyed more than 3000 undergraduates enrolled in chemistry courses. Survey responses showed all groups arrived on campus with similar interests in learning more about science research. Over the 4 years of college, WR students maintained their interest levels, but UR students did not, creating a widening gap between the groups. Without intervention, UR students participated in lab research at lower rates than their WR peers. A case study pilot program, Biosciences Collaborative for Research Engagement (BioCoRE), encouraged STEM research exploration by undergraduates from marginalized communities. BioCoRE provided mentoring and programming that increased community cohesion and cultivated students' intrinsic scientific mindsets. Our data showed that there was no statistical significant difference between BioCoRE WR and UR students when surveyed about plans for a medical profession, graduate school, and laboratory scientific research. In addition, BioCoRE participants reported higher levels of confidence in conducting research than non-BioCoRE Scholars. We now have the highest annual number of UR students moving into PhD programs in our institution's history.
Topics: Engineering; Humans; Minority Groups; Students; Technology; Universities
PubMed: 35324271
DOI: 10.1187/cbe.20-06-0111 -
JAMA Jun 2023The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized... (Comparative Study)
Comparative Study
IMPORTANCE
The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).
OBJECTIVE
To evaluate academic medical culture, faculty mental health, and their relationship.
DESIGN, SETTING, AND PARTICIPANTS
A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health.
EXPOSURES
Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status.
MAIN OUTCOMES AND MEASURES
Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health.
RESULTS
Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis.
CONCLUSIONS AND RELEVANCE
High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
Topics: Female; Humans; Male; Ethnicity; Incivility; Sexual and Gender Minorities; Sexual Harassment; Workplace; Academic Medical Centers; Cyberbullying; Working Conditions; Organizational Culture; Social Marginalization; Minority Groups; Mental Health; Faculty, Medical; Medicine; United States; Asian; White; Surveys and Questionnaires; Racism; Sexism; Prejudice
PubMed: 37278814
DOI: 10.1001/jama.2023.7232 -
Current Opinion in Allergy and Clinical... Jun 2020In asthma, there is an increasing focus on personalizing treatment by targeting treatable traits. Ethnicity has effects on many biological and behavioural traits, and so... (Review)
Review
PURPOSE OF REVIEW
In asthma, there is an increasing focus on personalizing treatment by targeting treatable traits. Ethnicity has effects on many biological and behavioural traits, and so is an important consideration when personalizing asthma care. This review has particular relevance in light of current patterns of international migration, which are leading to unprecedented levels of ethnic heterogeneity in many geographic regions.
RECENT FINDINGS
This review examines the effect of ethnicity on three key domains - biological traits, behavioural traits and health system behaviour. Ethnicity influences asthma biology by affecting biomarker reference ranges, response to drug therapy and asthma phenotypes. Ethnicity impacts behavioural traits through its effects on psychosocial well being, adherence and asthma self-management. Ethnic minorities are often disadvantaged with regards to healthcare access and healthcare interactions.
SUMMARY
Concerted action is needed to address current issues around behavioural traits and healthcare behaviour, which are influenced by ethnicity. More research is required to understand the impact of ethnicity on asthma biology, especially the interplay between genetic and environmental influences on asthma, and the differential response to asthma therapies.
Topics: Asthma; Emigration and Immigration; Ethnicity; Health Services Accessibility; Healthcare Disparities; Humans; Minority Groups; Patient Compliance; Precision Medicine; Self-Management; Socioeconomic Factors
PubMed: 31850922
DOI: 10.1097/ACI.0000000000000609