Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging.

中文翻译：

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公平、多样性和……排斥？加拿大本科医学教育“归属感”的全国混合方法研究。

公平、多样性和包容性仍然是医学院的一个突出重点，但“归属感”现象可能被忽视了。对于来自面临系统性压迫和排斥的群体的医学生如何体验归属感，人们知之甚少。我们采用顺序解释性混合方法设计来探索来自应得公平群体 (EDG) 的学生在医学院期间如何体验归属感，包括女性、种族、土著、残疾人和 2SLGBTQIA+ 学生。首先，我们对医学生（N = 480）进行了一项全国横断面调查，测量了四个概念：归属感、冒名顶替综合症、倦怠和抑郁。EDG 学生的归属感得分总体较低，更具体地说，在少数族裔学生中归属感得分明显最低。结构方程模型表明，归属感差先于冒名顶替综合症，并进一步加剧倦怠和抑郁。接下来，我们对 EDG 的归属感得分明显最低的学生（N = 16）进行了抽样和访谈。参与者将归属感的本质描述为能够作为一个人的“真实的自我”存在，同时强调接受感、舒适感和安全感，以及被重视和视为平等的感觉——但也描述了“他者”的日常经历如何抑制这种感觉归属感，往往是由于社会身份和结构特权的差异。归属感差会对学习者的福祉和职业轨迹产生负面影响。我们阐明了与归属感减弱相关的一系列心理和职业后果，并强调需要扩大公平、多样性和包容性的传统概念，以考虑归属感的结构性障碍。