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Informal training experiences contribute to changes in racial bias among medical students

In a study published in Social Psychology Quarterly, Dr. Sara Burke and colleagues examined the effects of both formal and informal experiences on non-African American medical students’ attitudes toward African Americans.

Key findings:

  • Interracial contact was an important predictor of positive attitudes toward African Americans.
  • Students who witnessed instructors make negative racial comments or jokes were significantly more willing to express racial bias themselves.
  • Formal training on issues related to racial bias was not significantly associated with attitudes toward African Americans

According to the authors “explicit antiblack attitudes remain an active and pressing concern in medical training and demonstrate the urgency of addressing racial bias in the informal culture of medicine.”

 

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Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People

In a study published in the Journal of General Internal Medicine, Dr. Sean Phelan and colleagues examined how medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias against gay and lesbian people.

Sean Phelan, PhD, MPH

Key findings:

  • In medical schools where faculty discrimination against LGBT patients was more common, students experienced an increase in bias toward gay and lesbian people over the course of medical school.
  • Students who felt more prepared to care for LGBT patients had lower bias toward gay and lesbian people.
  • Both the amount of contact with sexual minorities and the perceived quality of that contact were associated with reduced bias during medical school.

Medical student biases toward sexual minorities may improve during medical school with training in providing care to sexual minorities, improved diversity climate, less negative role modeling, and more favorable interaction with sexual minorities.

 

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Medical Student CHANGE & Medical Trainee CHANGE Studies were funded by two R01 grants from the National Heart, Lung and Blood Institute, National Institutes of Health*.  The study was originally conceived by Michelle van Ryn, PhD (Principal Investigator) and John (Jack) Dovidio, PhD (Yale Site Investigator) in order to determine whether medical training factors had an impact on physician biases and/or equity of care.

The primary purpose of the studies is to examine the impact of medical school and residency organizational climate, role model behavior, and formal and informal training experiences on new physician characteristics (well-being, attitudes, and practices) associated with disparities in care.

The secondary purpose of the studies is to examine the impact of medical school and residency characteristics on outcomes among new physicians who are members of marginalized social groups (under-represented minority, sexual minority, and have obesity).

*NHLBI, NIH, 1 RO1 HL085631 (2009-2015) and NHLBI, NIH, 2 RO1 HL085631 (2015-2019)

Medical School and Medical Trainee Changes Core Conceptual Model

Medical Student & Medical Trainee CHANGE Studies are longitudinal cohort studies of a single sample of physicians-in training.

Sample: 4732 trainees recruited in beginning of their first year in a stratified random sample of 49 medical schools

  • 81% response rate of those invited to participate
  • 55% of all 1st year students in those schools in 2009

Measurement points:

  • T1: Fall of first year of medical school (2009)
  • T2: Spring of last year of medical school (2014)
  • T3: Limited set fall of first year of residency (2014)
  • T4: Winter/spring of 2nd year of residency (2016)
  • T5: End of 3rd year of residency (2017)
  • T6: (To be conducted in Fall, 2018)

Medical students’ learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES. (2016). Burgess, D. J., Burke, S. E., Cunningham, B. A., Dovidio, J. F., Hardeman, R. R., Hou, Y., . . . van Ryn, M. BMC Med Educ, 16(1), 254. doi:10.1186/s12909-016-0769-z

Stereotype threat and health disparities: what medical educators and future physicians need to know. (2010). Burgess, D. J., Warren, J., Phelan, S., Dovidio, J., & van Ryn, M. J Gen Intern Med, 25 Suppl 2, S169-177. doi:10.1007/s11606-009-1221-4

Beyond Generalized Sexual Prejudice: Need for Closure Predicts Negative Attitudes Toward Bisexual People Relative to Gay/Lesbian People. (2017). Burke, S. E., Dovidio, J. F., LaFrance, M., Przedworski, J. M., Perry, S. P., Phelan, S. M., . . . van Ryn, M. Journal of Experimental Social Psychology, 71, 145-150. doi:10.1016/j.jesp.2017.02.003

Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study. (2015). Burke, S. E., Dovidio, J. F., Przedworski, J. M., Hardeman, R. R., Perry, S. P., Phelan, S. M., . . . van Ryn, M. Acad Med, 90(5), 645-651. doi:10.1097/ACM.0000000000000661

Medical student socio-demographic characteristics and attitudes toward patient centered care: do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study. (2015). Hardeman, R. R., Burgess, D., Phelan, S., Yeazel, M., Nelson, D., & van Ryn, M. Patient Educ Couns, 98(3), 350-355. doi:10.1016/j.pec.2014.11.013

Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. (2016). Hardeman, R. R., Perry, S. P., Phelan, S. M., Przedworski, J. M., Burgess, D. J., & van Ryn, M. J Racial Ethn Health Disparities, 3(2), 250-258. doi:10.1007/s40615-015-0136-5

Association Between Perceived Medical School Diversity Climate and Change in Depressive Symptoms Among Medical Students: A Report from the Medical Student CHANGE Study. (2016). Hardeman, R. R., Przedworski, J. M., Burke, S., Burgess, D. J., Perry, S., Phelan, S., . . . van Ryn, M. J Natl Med Assoc, 108(4), 225-235. doi:10.1016/j.jnma.2016.08.005

Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study. (2015). Hardeman, R. R., Przedworski, J. M., Burke, S. E., Burgess, D. J., Phelan, S. M., Dovidio, J. F., . . . van Ryn, M. J Racial Ethn Health Disparities, 2(3), 403-413. doi:10.1007/s40615-015-0087-x

Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students’ Negative Attitudes toward Higher-Weight Patients. (2017). Meadows, A., Higgs, S., Burke, S. E., Dovidio, J. F., van Ryn, M., & Phelan, S. M. Front Psychol, 8, 504. doi:10.3389/fpsyg.2017.00504

The joint effect of bias awareness and self-reported prejudice on intergroup anxiety and intentions for intergroup contact. (2015). Perry, S. P., Dovidio, J. F., Murphy, M. C., & van Ryn, M. Cultur Divers Ethnic Minor Psychol, 21(1), 89-96. doi:10.1037/a0037147

The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study. (2016). Perry, S. P., Hardeman, R., Burke, S. E., Cunningham, B., Burgess, D. J., & van Ryn, M. J Racial Ethn Health Disparities, 3(3), 519-526. doi:10.1007/s40615-015-0170-3

Beliefs about the causes of obesity in a national sample of 4th year medical students. (2015). Phelan, S. M., Burgess, D. J., Burke, S. E., Przedworski, J. M., Dovidio, J. F., Hardeman, R., . . . van Ryn, M. Patient Educ Couns, 98(11), 1446-1449. doi:10.1016/j.pec.2015.06.017

The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey. (2015). Phelan, S. M., Burgess, D. J., Puhl, R., Dyrbye, L. N., Dovidio, J. F., Yeazel, M., . . . van Ryn, M. J Gen Intern Med, 30(9), 1251-1258. doi:10.1007/s11606-015-3266-x

Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. (2015). Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. Obes Rev, 16(4), 319-326. doi:10.1111/obr.12266

Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students. (2017). Phelan, S. M., Burke, S. E., Hardeman, R. R., White, R. O., Przedworski, J., Dovidio, J. F., . . . van Ryn, M. J Gen Intern Med, 32(11), 1193-1201. doi:10.1007/s11606-017-4127-6

Implicit and explicit weight bias in a national sample of 4,732 medical students: the medical student CHANGES study. (2014). Phelan, S. M., Dovidio, J. F., Puhl, R. M., Burgess, D. J., Nelson, D. B., Yeazel, M. W., . . . van Ryn, M. Obesity (Silver Spring), 22(4), 1201-1208. doi:10.1002/oby.20687

The mixed impact of medical school on medical students’ implicit and explicit weight bias. (2015). Phelan, S. M., Puhl, R. M., Burke, S. E., Hardeman, R., Dovidio, J. F., Nelson, D. B., . . . van Ryn, M. Med Educ, 49(10), 983-992. doi:10.1111/medu.12770

Response to Capsule Commentary. (2018). Phelan, S. M., van Ryn, M., & Team, C. S. J Gen Intern Med, 33(4), 403. doi:10.1007/s11606-018-4313-1

A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From the Medical Student CHANGE Study. (2015). Przedworski, J. M., Dovidio, J. F., Hardeman, R. R., Phelan, S. M., Burke, S. E., Ruben, M. A., . . . van Ryn, M. Acad Med, 90(5), 652-659. doi:10.1097/ACM.0000000000000658

The Impact of Racism on Clinician Cognition, Behavior, and Clinical Decision Making. (2011). van Ryn, M., Burgess, D. J., Dovidio, J. F., Phelan, S. M., Saha, S., Malat, J., . . . Perry, S. Du Bois review : social science research on race, 8(1), 199-218. doi:10.1017/S1742058X11000191

Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report. (2015). van Ryn, M., Hardeman, R., Phelan, S. M., Burgess, D. J., Dovidio, J. F., Herrin, J., . . . Przedworski, J. M. J Gen Intern Med, 30(12), 1748-1756. doi:10.1007/s11606-015-3447-7

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study. (2014). van Ryn, M., Hardeman, R. R., Phelan, S. M., Burke, S. E., Przedworski, J., Allen, M. L., . . . Dovidio, J. F. Patient Educ Couns, 96(3), 367-375. doi:10.1016/j.pec.2014.06.009

Response to Dr. Westfall. (2016). van Ryn, M., & Phelan, S. M. J Gen Intern Med, 31(7), 715. doi:10.1007/s11606-016-3683-5