More Work, Less Reward: The Minority Tax on US Medical Students

Introduction: Minority tax is defined as the burden of time and resources placed on minority persons to represent and advocate for their communities. We determined whether medical students underrepresented in medicine (URM) or from historically excluded (HE) populations experience a minority tax and characterized its effects. Methods: This cross-sectional survey of US medical students occurred November 2020 - June 2021. We used Mann-Whitney U tests to compare metrics between URM and HE participants and their peers. The primary outcome was time invested in activism/diversity initiatives versus other work. Secondary outcomes included measures of microaggressions, discrimination, institutional culture, anxiety/depression, mentorship, and sleep. We performed thematic analysis of open-ended questions about participants’ experiences with minority tax. Results: A total 282 students included 39 (13.8%) URM and 150 (53.9%) HE participants. Compared to peers, URM and HE participants invested an additional 36.4 (p = 0.005) and 46.8 (p = 0.006) annual hours on advocacy and 62.4 (p \u3c 0.001) and 41.6 (p = 0.001) annual hours on diversity initiatives, respectively. URM and HE participants reported more microaggressions / discrimination, less inclusive environments, and no differences in access to mentorship or sleep. Six themes were evident: (1) URM and HE students feel obligated to do diversity, equity, and inclusion (DEI) work, (2) students doing DEI work experience minority tax, (3) minority tax is negatively associated with wellness, (4) learning environment changes may mitigate minority tax, (5) there is a demand for increased representation and improved DEI education, and (6) an increased DEI budget might reduce the minority tax for students. Conclusion: URM and HE medical students experience a minority tax that may affect their wellbeing. These findings should serve as a call for action by medical school leaders

Perspectives and Experiences of Transgender and Non-binary Individuals on Seeking Urological Care.

OBJECTIVE: To describe perspectives and experiences related to urology care-seeking of transgender and non-binary (TGNB) individuals assigned male at birth. MATERIALS AND METHODS: This HIPAA-compliant study was IRB approved and followed Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines. Through semistructured interviews, perspectives, and experiences of individuals related to urology care-seeking were explored. Open-ended questions were designed to elicit a range of responses rather than quantifiable data. Thematic codes were developed and explicitly defined. Codes pertaining to patient experiences were assessed and described. RESULTS: Twenty-five TGNB individuals assigned male at birth were interviewed. Participants reported an array of factors that informed and inhibited care-seeking, factors that framed individual urologic care experiences, and their overall impression of the healthcare system\u27s ability to effectively and respectfully serve the TGNB population. Specifically, participants reported that prior negative healthcare experiences dissuaded them from seeking care such as feeling discriminated against and having a lack of trust in providers. Additionally, participants reported feeling a need and responsibility to educate providers on both their medical needs and psychosocial experiences. Participants were also unclear how best to identify trans-friendly urologists who are culturally competent and have appropriate medical knowledge. CONCLUSION: TGNB individuals face significant barriers to care for unique healthcare needs. TGNB participants described care avoidance and reported experiences of healthcare discrimination. These data highlight the importance for urologists to understand the perspectives and historical experiences of these individuals who may seek urological care

Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients\u27 Needs

Introduction: Medical providers may not be familiar with the genitourinary and sexual symptoms of transgender and non-binary (TGNB) individuals. This lack of familiarity may hinder a provider\u27s ability to address these issues as patients may hesitate to report symptoms due to fear of stigma, misgendering, and being treated disrespectfully. Aim: To describe the array of genitourinary and sexual symptoms in transfeminine individuals. Methods: Upon institutional review board approval, researchers used semi-structured interviews with 25 transfeminine individuals assigned male at birth to explore urinary and sexual symptoms on a sample of convenience. Participants were recruited and interviews were conducted until saturation was achieved. Two research assistants independently coded all de-identified transcripts and resolved discrepancies. Outcomes: Thematic codes pertaining to genitourinary and sexual symptoms were defined and assessed in this study. Results: Some genitourinary symptoms unrelated to hormone therapy or genital gender-affirming surgery (GGAS) included frequency, urgency, nocturia, and incontinence, while those attributed to GGAS included slow stream, spraying, and retention. Sexual symptoms unrelated to hormone therapy or GGAS included sexually transmitted infections, erectile dysfunction, and low libido. Sexual symptoms related to GGAS included delayed ejaculation, penile pain, scar tissue pain, and pain with receptive vaginal penetration. Clinical implications: Increased provider awareness of and accountability for the treatment of genital and sexual symptoms of transfeminine individuals. Strengths and limitations: Open-ended questions were used to generate a range of responses and perspectives through conversation instead of quantifiable data. Findings are not applicable to all TGNB people since participants were limited to transfeminine adults assigned male at birth only. Recruitment was limited by the sensitive nature of the topic and hard-to-reach populations and relied on convenience through flyers and a chain-referral sampling approach. Conclusion: Transfeminine individuals experience a wide array of genitourinary and sexual symptoms both similar and different to their cis gender counterparts. Chung PH, Swaminathan V, Spigner S, et al. Genitourinary and Sexual Symptoms and Treatments in Transfeminine Individuals: A Qualitative Exploration of Patients\u27 Needs. Sex Med 2022;XX:XXXXXX

Photo Elicitation Study 2018-2019

Photographer and researcher John Collier first named photo elicitation in a paper published in 1957. Photo elicitation involves a qualitative interview stimulated and guided by participant photographs. This method can help break down barriers between researchers and participants and can promote rich and collaborative discussions (Harper, 1994). Student Perspectives on Work-Life Balance: A Photo Elicitation Study Each student in Qualitative Research Methods (PBH 512, Summer 2018) recruited a study participant (n=12) from across the colleges of Thomas Jefferson University. Students trained participants in the appropriate and ethical use of this method. Study participants were asked to define and explore the meaning of work-life balance in their daily lives and were instructed to use their phones to document their exploration over the course of one week. Using the participant-generated photographs to guide a conversation, each member of the research team then conducted an interview with a participant. Healthy Eating: Student Perspectives on Food and Diet Each student in the Qualitative Research Methods class (PBH 512, Summer 2019) recruited a Thomas Jefferson Student who lives on campus (n=12). Students trained participants in the appropriate and ethical use of this method. Study participants were asked to reflect on their experiences of food and eating in their daily lives. They were instructed to use their phones to document their exploration for one week. Using the participant-generated photographs to guide a conversation, each member of the research team then conducted an interview with a participant