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Abstract: FR-PO051

Reimagining Safety in the Learning Environment: A Grounded Theory Exploration of Identity Safety in Clinical Medical Students

Session Information

  • Educational Research
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 1000 Educational Research


  • Bullock, Justin L., University of Washington, Seattle, Washington, United States
  • Sukhera, Javeed, Hartford HealthCare Institute of Living, Hartford, Connecticut, United States
  • del Pino Jones, Amira, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States
  • Dyster, Timothy G., University of California San Francisco, San Francisco, California, United States
  • Ilgen, Jonathan Seth, University of Washington, Seattle, Washington, United States
  • Lockspeiser, Tai M., University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States
  • Teunissen, Pim, Universiteit Maastricht, Maastricht, Limburg, Netherlands
  • Hauer, Karen E., University of California San Francisco, San Francisco, California, United States

Trainees in nephrology who identify as underrepresented in medicine and/or international medical graduates are at high risk for identity threats such as stereotype threat and microaggressions. Identity threats impair learning and erode well-being. In contrast to identity threat, less is known about how learners experience feelings of safety regarding their identity. This exploratory study aims to develop a theory of identity safety in the clinical learning environment.


This multi-institutional, qualitative interview study was informed by constructivist grounded theory and critical pedagogy. Participants were clinical students at three US medical schools. Investigators purposively sampled interviewees based on their responses to an 11-item survey with an open-ended question soliciting students’ personal identities and their scores on the racial/ethnic and gender Stereotype Vulnerability Scales. The investigators interviewed, coded, constantly compared, and continued sampling in alignment with grounded theory. The team engaged in critical reflexivity throughout the analytic process to enrich data interpretations.


Sixteen diverse students were interviewed. We organized their identity salient experiences into identity safety, identity threat, and threat mitigation. Identity safety occurred when learners existed as their authentic selves without feeling the need to monitor others' perception of their identities. This arose when: 1) learners demonstrated agency to leverage their identities for patient care, 2) others upheld their personhood and saw them as unique individuals, and 3) learners felt they belonged. Participants experienced identity threat when they experienced stereotype threat or interpersonal threat. Threat mitigation occurred when someone intervened against an identity threat, dampening but not eliminating the impact of the identity threat.


Identity safety may foster learning by liberating learners from self-monitoring, insulating them from identity threats, and enabling them to leverage their identities to contribute to patient care.