Upholding Our PROMISE: Negotiating Belonging and Professional Identity Formation in Underrepresented in Medicine...

To explore UIM pediatric residents' perspectives on how belonging impacts PIF and Well-BP.

We conducted a national qualitative study grounded in a critical interpretivist paradigm using virtual focus groups with UIM pediatric residents between June 2022 and April 2023. Data were analyzed by 4 authors using reflexive thematic analysis until theoretical sufficiency was reached. Member-checking was conducted to ensure the trustworthiness of the themes.

Twenty-four UIM pediatric residents across 20 programs participated. Five themes emerged as follows: 1) Belonging is a dynamic process shaped by daily affirmations and invalidations; 2) Clinical learning environments often erode belonging through microaggressions and lack of accountability for bias; 3) UIM residents face unique challenges such as tokenism, stereotype threat, and the weaponization of professionalism; 4) Tensions exist between the motivation to stay in academic medicine and choosing alternative career paths; 5) UIM pediatric residents identified belonging interventions at the residency program, institution and national level to support PIF and Well-BP.

For UIM pediatric residents, PIF is an active negotiation rather than a passive internalization of norms, with belonging serving as the primary mediator. Residency programs can apply insights from this study to design belonging interventions that support UIM pediatric residents' PIF and Well-BP.