The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students.

BACKGROUND: Black medical students have been consistently underrepresented in Canadian medical schools, and data on the impact of discrimination on their medical education remain limited. In this cross-sectional study, we aimed to investigate the experiences of Black medical students through the Black Medical Students' Association of Canada (BMSAC). METHODS: We developed a 63-item instrument around the domains of inclusion and diversity, wellness, discrimination, career advancement and diversity in medical education. The anonymous web-based questionnaire was sent to 128 medical students and first-year residents from all 17 Canadian medical schools via the BMSAC listserv. We obtained frequencies for demographic data and self-reported experiences. RESULTS: We received 52 responses. Of respondents, 59% had at least 1 personal encounter with discrimination in medical school. Discrimination was experienced in both clinical and academic contexts, notably from patients, peers and hospital staff. Students further along in their medical training were more likely to endorse having experienced discrimination in medical school. Most respondents had positive experiences with academic and clinical inclusion, as well as resiliency in the face of discrimination. However, most respondents had negative experiences relating to reporting discrimination, their well-being, career advancement, sentiments of minority tax and low diversity in medical education. INTERPRETATION: We found that discrimination has important implications on the learning experiences of Black medical students surveyed from the BMSAC. This directly challenges the notion that Canadian medical schools are impervious to racism and highlights the need for advocacy and systemic changes to eliminate institutional racism.

Bridging the gap: improving CASPer test confidence and competency for underrepresented minorities in medicine through interactive peer-assisted learning.

BACKGROUND: The Computer-based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgement test (SJT) adopted by medical schools to assess applicants' interpersonal skills. CASPer applicants must compose their responses to ethical dilemmas, thereby highlighting the applicant's rationale for ethical decision-making. Minority applicants usually lack access to a network of individuals who can offer guidance and expertise on ethical decision-making. As such, this study investigated the impact of a CASPer coaching program designed for minority applicants. METHODS: A free online intervention was designed to help minority applicants prepare for the CASPer test. The program consisted of 35 learners and three medical student tutors. Important attributes of the 4-week program included free access to a medical ethics book, feedback provision to in-class and homework student responses, and facilitation of a mock CASPer. Course feedback was collected. Additionally, a pre and post-program survey was administered to assess learners' competence and confidence surrounding CASPer test-taking. RESULTS: Our pre and post-program survey showed significant student improvement in familiarity with the test, increased competence, confidence and preparedness, as well as reduced anxiety (p < 0.05). CONCLUSIONS: Through peer-to-peer teaching and access to medical student mentors, our program addresses socioeconomic barriers that several minority applicants face when applying to medical school.

CONTEXTE: L'évaluation informatisée des caractéristiques personnelles (CASPer) est un test de jugement situationnel (TJS) adopté par les facultés de médecine pour évaluer les compétences interpersonnelles des candidats à l'admission. Les candidats à l'examen CASPer sont invités à répondre à des dilemmes éthiques pour montrer leur raisonnement dans la prise de décisions éthiques. Les candidats issus de minorités n'ont souvent pas accès à des personnes qui peuvent leur offrir des conseils et une expertise en matière de prise de décision éthique. La présente étude examine l'impact d'un programme de soutien du CASPer conçu pour les candidats issus des minorités. MÉTHODES: Un programme d'assistance gratuite en ligne d'une durée de quatre semaines a été conçu pour aider les candidats issus de minorités à se préparer à l'examen CASPer. L'encadrement était offert à 35 apprenants par trois tuteurs étudiants en médecine. Les principales caractéristiques du programme comprenaient l'accès sans frais à un manuel d'éthique médicale, un retour sur les réponses en classe et sur les devoirs, et l'animation d'un examen CASPer simulé. Nous avons recueilli les réactions des apprenants au programme et nous avons réalisé un sondage avant et après le programme pour évaluer les compétences et la confiance des étudiants en ce qui concerne l'examen CASPer. RÉSULTATS: Le sondage a montré qu'après le programme, les candidats avaient une bien meilleure connaissance du test, que leurs compétences, leur confiance et leur préparation s'étaient améliorées, et que leur niveau d'anxiété avait baissé (p < 0,05). CONCLUSIONS: Grâce au recours à l'apprentissage entre pairs et au mentorat par des étudiants en médecine, notre programme s'attaque aux obstacles socio-économiques que les candidats qui sont issus de minorités rencontrent dans le processus d'admission dans les facultés de médecine.

HIV nonoccupational postexposure prophylaxis for sexual assault cases: a 3-year investigation.

OBJECTIVE: Nonoccupational postexposure prophylaxis (nPEP) programs offer antiretroviral therapy to prevent HIV following at-risk exposures like sexual assault. We investigated the levels of elective nPEP uptake among sexual assault cases presenting for emergency medical care. DESIGN: Retrospective analysis. METHODS: The analysis included over 3 years (1 January 2015 to 30 September 2018) of clinic information from the Sexual Assault and Partner Abuse Care Program (SAPACP) at The Ottawa Hospital, the regional emergency department care point following sexual assault. Descriptive analyses assessed the number of cases eligible for nPEP and those who started nPEP. Bivariable/multivariable logistic regression modelling assessed factors most strongly associated with starting nPEP using odds ratios (OR), adjusted OR (AOR), and 95% confidence intervals (CI). RESULTS: The SAPACP saw 1712 patients; 1032 were sexual assault cases, 494 were eligible for nPEP, and 307/494 (62%) eligible patients started nPEP. The median age was 23 years (IQR: 20-31), with 446 (90%) cases being female. There were 86 (17%) cases who arrived by ambulance, and 279 (56%) assaults involving a known assailant. Reduced odds of starting nPEP were observed among female cases (AOR: 0.44, 95% CI: 0.21-0.93), those who arrived by ambulance (AOR: 0.56, 95% CI: 0.35-0.91), and those with a known assailant (AOR: 0.56, 95% CI: 0.36-0.78). CONCLUSION: We found that 62% of eligible sexual assault cases started nPEP. Key groups most likely to decline nPEP included female cases, those who arrived by ambulance, and those with known assailants. Providers can use these findings to provide recommendations to sexual assault survivors most likely to decline nPEP, yet still in need of care.