Ethno-racial trauma and well-being in medical education: A scoping review of U.S. physician trainees and medical students

Background/purpose: Burnout, elevated psychological distress, and reduced flourishing undermine the well-being of physician trainees and may ultimately compromise patient care. Exposure to ethno-racial trauma (ERT) can disrupt trainees’ personal and professional identity formation and impede their learning experiences. This scoping review aims to synthesize the existing literature on how ERT affects the well-being of medical trainees. Methods: This review was conducted according to JBI methodology. A literature search of six bibliographic databases and one grey literature source was conducted in August 2023, and updated in June 2024, without time restriction applied. All English language studies conducted in the US that assessed the impact of ERT on physicians and/or physician trainees were included. Results: Of the 4656 manuscripts identified for initial screening, 534 studies underwent full-text review, and 92 studies met inclusion criteria, with 45 studies focused on physician trainees alone and 18 focused on both physicians and physician trainees. Included studies were published between 1987 and 2024, with the majority of quantitative (49%) or qualitative (30%) methodology. Most frequently reported forms of ERT experienced by physician trainees included microaggressions, discrimination, implicit bias, invisibility, lack of belonging, devaluation of works, and disrespectful actions. Faculty, peers, patients, other practitioners and staff, community members, and medical school administrators were identified as sources of ERT. ERT was most often associated with burnout, isolation, and stress, and negatively impacted confidence, emotions, learning experience, and mental health. ERT impacted all domains of PERMA in this literature review. Conclusion: Current literature indicates that ERT has profound negative effects on physician trainees’ well-being, contributing to burnout, psychological distress, and diminished sense of belonging. These impacts erode professional identity, hinder learning, and threaten long-term career satisfaction. Prospective, interventional studies are needed to further delineate the effects of ERT on trainees’ well-being and inform strategies to mitigate these effects.