A Qualitative Exploration of Sense of Belonging among Learners in Graduate Medical Education

Abstract

University of Washington Abstract: A Qualitative Exploration of Sense of Belonging among Learners in Graduate Medical Education Derrick Thiel Chair of the Supervisory Committee: Todd Edwards Department of Health Services Purpose: Diversity, Equity, and Inclusion efforts are receiving increasing and overdue recognition. In graduate medical education (GME) there have been efforts to improve diversity in physician training and while there is data on the experiences of underrepresented in medicine (URiM) populations in GME, there is a paucity of data on how physicians-in-training (residents) navigate the process and feelings of “belonging” during residency and how their personal identity characteristics relate to this process. The purpose of this study is to further describe and define this process for GME learners with an emphasis on learners from URiM populations. Methods: Working from a constructionist research orientation, the research team utilized in-person focus groups, virtual focus groups, and individual interviews to examine the process and feelings of "belonging" in GME residents at the University of Washington School of Medicine. Participants who were unable or unwilling to attend in-person or virtual sessions were invited to take an online survey. Interviews were supplemented by individual reflection and writing time prior to discussion. Data was transcribed and inductively analyzed utilizing thematic analysis. Member-checking was performed after codebook development, thematic analysis, and creation of a proposed definition of belonging as it manifests in GME. Results: In total, 24 individuals participated in real-time reflection and discussion (12 in-person and 12 virtual), while 5 participants responded to the online survey of the same questions. Participants identified as primarily from medical specialties, were mostly of allopathic backgrounds, and were approximately 50% female. More than half of the participants were Black, Indigenous, or People of Color (BIPOC), and one-quarter were from URiM populations. In total, 7 major themes were derived from nearly 40 subthemes and approximately 900 codes. Themes derived from the dataset relating to belonging included the importance of feeling personally valued and having opportunity within the medical system, as well as the importance of interactions to the process of building relationships (both with the self and with others). Participants noted that their identity characteristics (gender identity, race/ethnicity, etc.) are interpreted as similar or different to others within medicine and may contribute or detract from sensations of belonging.