Measuring Sense of Belonging Among Current and Future Physicians: A Systematic Review

Sense of belonging (belongingness) is a psychological inference about the quality of fit or potential fit between a person and a social context. Although inconsistencies in its measurement have been documented in other fields, how belongingness is defined and operationalized in medicine remains unclear. This review synthesizes how researchers have conceptualized and quantitatively assessed belongingness and related constructs among physicians. This systematic review included original, English-language, peer-reviewed studies published through February 14, 2023, that measured sense of belonging (or a related, positively valenced construct) among medical students, residents, and/or practicing physicians using the keywords belongingness, social connectedness, social integration, relatedness, sense of community, and fitting in. The authors examined data at the study (e.g., participants, setting, location, methodologic and reporting quality), instrument (e.g., origin, use, rating scale attributes, validity evidence), and item (via thematic analysis of content) levels. Fifty-two studies met the eligibility criteria, encompassing 16,956 participants, 54 instruments (23 author created, 17 reproduced, 12 adapted, and 2 indeterminate), and 350 items (198 available verbatim). Instrument lengths ranged from 1 to 30 items (median, 4); 47 of 54 instruments (87%) used Likert-type rating scales (3-7 response options; median, 5). Sources of validity evidence for resulting scores included content (39 of 54 72%), relations to other variables (36 of 54 67%), internal structure (26 of 54 48%), and response process (4 of 54 7%). Of 198 items provided verbatim, 69 (35%) measured belongingness or a related, positively valenced construct. Items targeted perceptions of interpersonal connection and broader belonging to organizations or professional groups. Belongingness measures among physicians demonstrate substantial heterogeneity. Opportunities for improvement include addressing methodologic and reporting gaps, strengthening validity evidence, and enhancing conceptual clarity. These findings highlight areas for further development in how belongingness is measured across medical training contexts and health care organizations.