"Will I be able to be myself? Or will I be forced to lie all the time?": How Trans and Non-Binary Students Balance Professionalism, Authenticity, and Safety in Canadian Medical Programs.

Introduction: Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality healthcare to all patients. Existing data on the experiences of TNB physicians and trainees describe widespread challenges related to prejudice and discrimination, with most trainees concealing their gender identity for fear of discrimination. We aimed to understand how TNB medical students have experienced professionalism and professional identity formation. Methods: This was a secondary analysis of data gathered in a constructivist grounded theory study. The authors conducted semi-structured qualitative interviews in 2017 with seven current or recently graduated TNB Canadian medical students. Results and Discussion: From medical school application to graduation, TNB medical students reported feeling tensions between meeting expectations of professionalism, being their authentic selves, and seeking to avoid conscious and implicit biases. These tensions played out around issues of disclosure, foregrounding identity through impression management, and responding to identity exemplars. The tension between TNB trainees' desire to bring their whole selves to the practice of medicine and feeling pressured to de-emphasize their gender is ironic when considering the increased call for medical trainees from equity-seeking communities. The most commonly used behavioural frameworks of professionalism were inherited from prior generations and restrict students whose experiences and community-based knowledge are most needed. Demands of professionalism that are incompatible with authentic professional identity development place an inordinate burden on trainees whose identities have been excluded from normative concepts of the professional, including TNB trainees.

Transforming our relationship with the social determinants of health: a scoping review of social justice interventions in Canadian Medical Schools.

This article was migrated. The article was marked as recommended. Background/Purpose: Physicians are in a powerful position to improve the health status of communities through mitigating disparities rooted in social inequities. However, it is uncertain whether medical schools are preparing future physicians with the skills needed to care for diverse populations. The current scoping review aimed to describe how Canadian medical schools teach social justice, comparing pedagogical strategies. Methods: A search was performed using OVID to identify published studies of implemented and evaluated social justice-based interventions within Canadian medical school curricula. Results: Six studies were included. Common themes included increased content knowledge, greater understanding of SDoH, acknowledgement of power and privilege imbalances, identification of physicians' roles as advocates, emphasis on the importance of interdisciplinary care, and increased capacity for self-reflection and personal growth. Experiential interventions were associated with greater personal transformation, but had limited accessibility. Conclusion: Despite the widespread recognition of physicians' roles as health advocates, there is a lack of consensus about an effective strategy for teaching social justice in medical education in Canada. While additional research focusing on the relative merits of didactic versus experiential learning is needed, these preliminary results suggest that experiential learning emphasizing self-reflection and personal growth may be optimal when approaching transformative learning.

"Progress in Medicine Is Slower to Happen": Qualitative Insights Into How Trans and Gender Nonconforming Medical Students Navigate Cisnormative Medical Cultures at Canadian Training Programs.

PURPOSE: Trans and gender nonconforming (TGNC) people face significant health disparities compared with their cisgender (nontrans) counterparts. Physician-level factors play a role in these disparities, and increasing the participation of individuals from sexuality and gender minority (SGM) communities in medical training has been proposed as one way of addressing this issue; however, very little is known about the experiences of TGNC medical students. This study aimed to understand the experiences of TGNC medical students in Canada. METHOD: Between April 2017 and April 2018, 7 TGNC participants either currently enrolled in or recently graduated from a Canadian medical school completed audiorecorded semistructured interviews. Interviewers asked about experiences with admissions; academic, clinical, and social environments; and interactions with administration. The authors analyzed interviews using a constructivist grounded theory approach. RESULTS: The authors developed 5 overarching themes: navigating cisnormative medical culture; balancing authenticity, professionalism, and safety; negotiating privilege and power differentials; advocating for patients and curricular change; and seeking mentorship in improving access and quality of care to TGNC patients. This article focuses on the first theme, with associated subthemes of culture and context; interactions with classmates, curriculum, policy, and administration; and gendered spaces. CONCLUSIONS: The results of this study delineate heterogeneous experiences of medical cultures with a shared underlying pattern of erasure of TGNC people as both patients and clinicians. Findings were largely consistent with previously published recommendations for improving academic medical institutional climates for SGM people, though the need for access to appropriate gendered spaces beyond washrooms was highlighted.

The experience of providing care to relatives with chronic mental illness.

Research on family caregivers of mentally ill relatives has historically focused on negative aspects of caregiving, often described as caregiver burden. The authors document caregivers' perspectives on both the negative and positive aspects of caregiving. A qualitative approach was used. Data collection involved 20 in-depth, audiotaped, semistructured interviews focusing on caregivers' positive and negative personal experiences with caregiving to a relative with mental illness. Caregivers reported common negative impacts but also beneficial effects, such as feelings of gratification, love, and pride. Main themes included stigma, systems issues, life lessons learned, and love and caring for the ill relative. This study counterbalances the predominantly negative consequences previously reported and adds to the emerging literature on positive aspects of caregiving. Mental health professionals need to help caregiving families make choices to improve their challenging situations and identify the rewards of caregiving, and to advocate for increased systemic supports to ease caregiver burden.