Building Inclusion and Belonging in Training Environments

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) requires that programs engage in practices that prioritize recruitment and retention of a diverse workforce.1 To do so, graduate medical education (GME) programs must deliberately foster inclusive training environments with a genuine sense of belonging for all trainees, particularly those holding identities historically excluded from medicine. Yet creating these inclusive environments is fraught with challenges at the individual, interpersonal, and structural levels that interact in complex and often imperceptible ways.The dominant GME climate is the clinical learning environment (CLE), a microcosm where learning and patient care occur in tandem. These professional settings are variably welcoming to learners due to institutional culture, structures, spaces, and social interactions.2 When learners are excluded, harassed, or subjected to bias and discrimination in the CLE, overall well-being suffers, which can produce depression, burnout, and attrition.2Many institutions and programs aim to cultivate inclusive environments, yet the paradigm of inclusion typically assumes the subjugation of identities to adapt to a static medical culture designed by individuals with historical privilege and power. Underrepresented in medicine (UIM) residents describe being perceived as “other” in CLEs and must downplay core elements of their authentic selves to survive.3,4 Daily instances of micro- and macroaggressions, discrimination, bias, and racism3 negatively affect trainees' learning, ability to provide high-quality patient care, and well-being. Deliberately cultivating an environment of belonging in which everyone's authentic selves are valued, respected, and celebrated is imperative to ensure trainee success.5

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