Oriaku Kas-Osoka, University of Arkansas Medical Sciences Center
Courtney Gilliam, Cincinnati Children's Hospital
Lahia Yemane, Stanford School of Medicine
Rebecca Blankenburg, Stanford School of Medicine
Laura Kester Prakash, University of California Davis School of Medicine
Jyothi Marbin, University of California, Berkeley - San Francisco Joint Medical Program
Patricia Poitevien, Warren Alpert Medical School of Medicine at Brown University
Alan Schwartz, University of Illinois at Chicago
Candice Taylor Lucas, University of California, Irvine School of Medicine/CHOC
Purpose
While disparities in belonging for Underrepresented in Medicine (UIM) pediatric residents are known, the specific institutional practices that erode or foster it—and their direct impact on Professional Identity Formation (PIF)—remain less understood. This study addresses that gap, exploring how program, institutional, and community support affects UIM residents' belonging, well-being, and professional goals.
Methods
Adopting a PIF framework, this qualitative study explored the perspectives of 24 UIM pediatric residents in the U.S. Data were collected through 10 virtual focus groups from June 2022 to April 2023. The data then underwent inductive thematic analysis by four researchers, and the resulting findings were validated through member-checking.
Results
Five primary themes emerged. Residents described belonging as a fluid process, vulnerable to daily interactions. They reported an erosion of belonging from clinical microaggressions and feelings of isolation from being "the only one." The cognitive strain of hypervigilance impaired well-being. A lack of representation and mentorship actively pushed residents to reconsider or abandon careers in academic medicine. Finally, residents identified a need for support beyond symbolic diversity, advocating for dedicated diversity-focused advisors and individualized mentorship.
Conclusion
These findings show the foundational stages of PIF are disrupted for UIM residents when institutions fail to ensure stable belonging. To support authentic identity formation and retain these residents, programs must move beyond symbolic gestures and adopt tailored strategies, such as individualized mentorship and clear accountability for the institutional culture. While situated in the U.S. context, these insights offer a valuable framework for understanding the challenges faced by underrepresented trainees in health systems worldwide, essential for strengthening the global healthcare workforce.