Changing Obstetrics and Gynecology Residency Education to Combat Reproductive Injustice: A Call to Action.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
01 04 2021
01 04 2021
Historique:
received:
02
10
2020
accepted:
17
12
2020
pubmed:
12
3
2021
medline:
27
7
2021
entrez:
11
3
2021
Statut:
ppublish
Résumé
Although reproductive injustices and reproductive health disparities are well-documented in the United States, recent studies have begun to explore the health care professional's role in their perpetuation. We hypothesized that obstetrics and gynecology residents would observe reproductive injustices during their training. Thus, using a national survey, we asked obstetrics and gynecology residents to share clinical cases in which discrimination, bias, inequity, or injustice was involved in a patient's reproductive health care and queried their preparedness to respond. Through qualitative analysis, we found that respondents shared cases involving racism, discrimination, and structural barriers to care and that they felt poorly equipped to handle injustice. We call for clinician educators to combat reproductive injustice through three key changes to obstetrics and gynecology residency training: 1) incorporate reproductive justice training into formal residency education; 2) create safe spaces for residents to collectively debrief about their experiences with injustice and collaborate on care improvement; and 3) teach community engagement and advocacy skills that identify, center, and elevate local reproductive health priorities.
Identifiants
pubmed: 33706356
doi: 10.1097/AOG.0000000000004297
pii: 00006250-202104000-00024
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
717-722Informations de copyright
Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Financial Disclosure Charisse Loder reports that money was paid to them from Contemporary Ob/Gyn. Money was paid to their institution from the Society of Family Planning. The other authors did not report any potential conflicts of interest.
Références
Metzl JM, Roberts DE. Structural competency meets structural racism: race, politics, and the structure of medical knowledge. AMA J Ethics 2014;16:674–90. doi: 10.1001/virtualmentor.2014.16.09.spec1-1409
doi: 10.1001/virtualmentor.2014.16.09.spec1-1409
Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press; 2003.
Peterson E, Davis N, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/ethnic disparities in pregnancy-related deaths - United States, 2007–2016. Morb Mortal Wkly Rep 2019;68:762–5. doi: 10.15585/mmwr.mm6835a3
doi: 10.15585/mmwr.mm6835a3
Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. Am J Public Health 2010;100:489–95. doi: 10.2105/ajph.2009.160804
doi: 10.2105/ajph.2009.160804
Sabatino SA, Coates RJ, Uhler RJ, Breen N, Tangka F, Shaw KM. Disparities in mammography use among US women aged 40-64 years, by race, ethnicity, income, and health insurance status, 1993 and 2005. Med Care 2010;46:692–700. doi: 10.1097/MLR.0b013e31817893b1
doi: 10.1097/MLR.0b013e31817893b1
Gordon NH. Socioeconomic factors and breast cancer in Black and White Americans. Cancer Metastasis Rev 2003;22:55–65. doi: 10.1023/a:1022212018158
doi: 10.1023/a:1022212018158
Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract 2004;53:721–30.
Hardeman RR, Medina EM, Kozhimannil KB. Dismantling structural racism, supporting Black lives and achieving health equity: our role. N Engl J Med 2016;375:2113–5. doi: 10.1056/nejmp1609535
doi: 10.1056/nejmp1609535
Anderson KO, Green CR, Payne R. Racial and ethnic disparities in pain: causes and consequences of unequal care. J Pain 2009;10:1187–204. doi: 10.1016/j.jpain.2009.10.002
doi: 10.1016/j.jpain.2009.10.002
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proc Natl Acad Sci U S A 2016;113:4296–301. doi: 10.1073/pnas.1516047113
doi: 10.1073/pnas.1516047113
Rust G, Nembhard WN, Nichols M. Racial and ethnic disparities in the provision of epidural analgesia to Georgia Medicaid beneficiaries during labor and delivery. Am J Obstet Gynecol 2004;191:456–62. doi: 10.1016/j.ajog.2004.03.005
doi: 10.1016/j.ajog.2004.03.005
Yee LM, Simon MA. Perceptions of coercion, discrimination and other negative experiences in postpartum contraceptive counseling for low-income minority women. J Health Care Poor Underserved 2011;22:1387–400. doi:10.1353/hpu.2011.0144
doi: 10.1353/hpu.2011.0144
Higgins JA, Kramer RD, Ryder KM. Provider bias in long-acting reversible contraception (LARC) promotion and removal: perceptions of young adult women. Am J Public Health 2016;106:1932–7. doi:10.2105/AJPH.2016.303393
doi: 10.2105/AJPH.2016.303393
Liang J, Wolsiefer K, Zestcott CA, Chase D, Stone J. Implicit bias toward cervical cancer: provider and training differences. Gynecol Oncol 2019;153:80–6. doi: 10.1016/j.ygyno.2019.01.013
doi: 10.1016/j.ygyno.2019.01.013
Novak N, Lira N, O'Connor K, Harlow S, Kardia S, Stern A. Disproportionate sterilization of Latinos under California's eugenic sterilization program, 1920-1945. Am J Public Health 2018;108:611–3. doi: 10.2105/ajph.2018.304369
doi: 10.2105/ajph.2018.304369
Roberts D. Killing the Black body: race, reproduction, and the meaning of liberty. Vintage Books; 1997.
American College of Obstetricians and Gynecologists. In solidarity: a message to the ACOG community. Accessed August 20, 2020. https://www.acog.org/News/News Articles/2020/06/In Solidarity A Message to the ACOG Community
American College of Obstetricians and Gynecologists. Our commitment to changing the culture of medicine and eliminating racial disparities in women’s health outcomes. Accessed August 20, 2020. https://www.acog.org/About/Our Commitment to Changing the Culture of Medicine and Eliminating Racial Disparities in Womens Health Outcomes
Ross L, Solinger R. Reproductive justice. University of California Press; 2017.
Sister Song. Reproductive justice. Accessed September 30, 2020. https://www.sistersong.net/reproductive-justice
Loder C, Minadeo L, Jimenez L. Bridging the expertise of advocates and academics to identify reproductive justice learning outcomes. Teach Learn Med 2020;32:11–22. doi: 10.1080/10401334.2019.1631168
doi: 10.1080/10401334.2019.1631168
Ying Y, Seabrook C. Health advocacy competency: integrating social outreach into surgical education. J Surg Educ 2019;76:756–61. doi: 10.1016/j.jsurg.2018.11.006
doi: 10.1016/j.jsurg.2018.11.006
DeCesare J, Jackson J. Advocacy skills in resident doctors. Clin Teach 2016;13:48–51. doi: 10.1111/tct.12366
doi: 10.1111/tct.12366
Howell BA, Kristal RB, Whitmire LR, Gentry M, Rabin TL, Rosenbaum J. A systematic review of advocacy curricula in graduate medical education. J Gen Intern Med 2019;34:2592–601. doi: 10.1007/s11606-019-05184-3
doi: 10.1007/s11606-019-05184-3