Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. (...) We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism. (shrink)

In Britain, Employment Tribunals (ET) adjudicate on whistleblowing legislation. They do so with the overriding aim to adjudicate cases fairly and justly, by hearing parties on an equal footing. This paper presents research questioning this rule-of-law assumption vis-a-vis power imbalances that relate to whistleblowing. Using multinomial logistic regression analysis, we analyse all cases at ET in England and Wales between 2015 and 2018, that included a whistleblowing claim and that went to preliminary hearing or beyond. We find that several variables (...) have an effect on the relative representational strength (RRS) at ET, but not on the outcome of the whistleblowing claim. However, whistleblowing claims brought in combination of discrimination claims (41%) have lower RRS and less favourable outcomes for the whistleblowing claim. (shrink)