“Underrepresented individuals often suffer from imposter syndrome, an internalized sense of not belonging or deserving their success or achievement, which can be devastating to growth and development.”
Belonging: The Missing Piece for Our Learners By Joel Moll, MD; Michelle Lall, MD, MHS and Sheryl L. Heron, MD, MPH for SAEM's Academy for Diversity & Inclusion in Emergency Medicine The United States continues to become more diverse in areas of race, ethnicity, sexual orientation, and gender identity; however, within emergency medicine, this diversity is not always reflected. Data shows that the demographics of current and future emergency physicians continues to lag behind that of the patients we serve (Table 1). Public data does not readily exist for representation in emergency medicine of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) colleagues, either in our current work force or those in training. Some older studies suggest that in general, LGBTQ+ individuals may be less likely to choose professional careers such as medicine and within medicine may be more likely to choose primary care due to concerns with acceptance. With the focus on gender and racial inequities in the past year many programs have intensified efforts to recruit a more diverse residency class. Focusing on demographic numbers is one way to measure progress and success, but it is not enough. As your residents who matched in emergency medicine (EM) and your EM bound students arrive to your departments this summer, the question is, do they feel like they belong? Underrepresented individuals often suffer from imposter syndrome, an internalized sense of not belonging or deserving their success or achievement, which can be devastating to growth and development. Some, such as those in the LGBTQ+ community, may also feel like they must conceal who they fundamentally are in order to have a successful career in medicine or in residency. Much energy and effort may be siphoned away during this formative time to simply deny or hide who they fundamentally are, leading to
Table 1: Demographics of EM residents, faculty, and US population Demographic
EM Residents2
Active EM Physicians2
U.S. Population3
Female
34.9%
28%
50.8%
Black
3.9%
4.5%
13.4%
Latino
4.9%
5.3%
18.5%
LGBTQ+
Unknown
Unknown
Estimated 5.6% (C )
isolation. However, a recent article in Harvard Business Review questioned this phenomenon of imposter syndrome notably as it pertains to women and women of color aptly stating that imposter syndrome puts the blame on individuals, without accounting for the historical and cultural contexts that are foundational to how it manifests in both women of color and white women. The impact of systemic racism, classism, xenophobia, and other biases was not a part of the scientific literature when the concept of imposter syndrome was developed. The authors posit that rather than aiming our attention at fixing women at work, we should focus on fixing the places where women work. This is certainly applicable to all minoritized and disadvantaged groups. Programs can and should be deliberate and dedicated to creating a sense of belonging, not just opportunity, in EM training. Medicine is a social profession, and a sense of belonging is critical to feeling safe and developing emotional connections and well-being during a challenging time in training. Without belonging, isolation and imposter feelings can easily interfere with training, performance, emotion, and even physical health. Fundamentally, our residents and students need to be well to learn. Equally, our faculty and staff from marginalized
groups must also feel a sense of belonging to effectively teach. Individual identities are complex, multifaceted, and unique. Assumptions by societal majorities should not be made regarding any aspect of an individual’s identity or needs. There are many new and current resources focused on creating a sense of belonging in the learning and work environments. Below are some recurring suggestions that will hopefully help create a sense of belonging for everyone in your department.
State and reinforce diversity, equity, and inclusion as a value.
Commitment to this concept should be broad and visible. Your mission statement and specific aims should reflect the environment you have or which you have a desire to create. The statement should be provided not only to the Accreditation Council for Graduate Medical Education (ACGME) and your graduate medical education office, but to every person in your department. You should remind your learners, faculty, and staff of this statement when you recruit, onboard, and develop your residents throughout their training. Actions should mirror words to create an environment of safety and belonging. continued on Page 16
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