title: Standing out and moving up: performance appraisal of cultural minority physicians.
abstract: Despite a growing diversity within society and health care, there seems to be a discrepancy between the number of cultural minority physicians graduating and those in training for specialization (residents) or working as a specialist in Dutch academic hospitals. The purpose of this article is to explore how performance appraisal in daily medical practice is experienced and might affect the influx of cultural minority physicians into specialty training. A critical diversity study was completed in one academic hospital using interviews (N = 27) and focus groups (15 participants) with cultural minority physicians and residents, instructing specialists and executives of medical wards. Data were digitally recorded and transcribed verbatim. A thematic and integral content analysis was performed. In addition to explicit norms on high motivation and excellent performance, implicit norms on professionalism are considered crucial in qualifying for specialty training. Stereotyped imaging on the culture and identity of cultural minority physicians and categorical thinking on diversity seem to underlie daily processes of evaluation and performance appraisal. These are experienced as inhibiting the possibilities to successfully profile for selection into residency and specialist positions. Implicit criteria appear to affect selection processes on medical wards and possibly hinder the influx of cultural minority physicians into residency and making academic hospitals more diverse. Minority and majority physicians, together with the hospital management and medical education should target inclusive norms and practices within clinical practice.
authors.affiliation: Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands. H.Leyerzapf@vumc.nl.
authors.forename: Hannah
authors.initials: H
authors.lastname: Leyerzapf
authors.affiliation: Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Tineke A
authors.initials: TA
authors.lastname: Abma
authors.affiliation: PGV (Pastoral and Spiritual Care), VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Reina R
authors.initials: RR
authors.lastname: Steenwijk
authors.affiliation: VUmc School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Gerda
authors.initials: G
authors.lastname: Croiset
authors.affiliation: Department of Medical Humanities, EMGO Institute for Health and Care Research, School of Medical Sciences, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Verdonk
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002321:Career Choice; D002322:Career Mobility; D018864:Cultural Diversity; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D008913:Minority Groups; D009426:Netherlands; D010560:Personnel Selection; D010820:Physicians / Q000600:supply & distribution*; D013038:Specialization; D013240:Stereotyping; D000078329:Workforce
keywords: Academic hospitals; Cultural minority physicians; Implicit criteria on professionalism; Performance appraisal; Specialty training