Racism in medical school — from subtle to overt levels — can affect medical students' intentions to practice in underserved areas as they progress toward graduation, new research indicates.
In a longitudinal study of 3756 students at 49 randomly selected US medical schools, Sean M. Phelan, PhD, MPH, an associate professor in the Division of Health Care Policy and Research at Mayo Clinic in Rochester, Minnesota, and colleagues looked at three general areas: racism in curricula and policies; racism in medical school culture and climate; and medical student attitudes and behaviors toward race.
They then calculated how answers to survey questions changed from beginning to end of medical school with data collected from 2010 to 2014 and how levels of racism affected intent to practice in underserved areas.
The findings, published in the August issue of Academic Medicine, "suggest that medical education leaders can take action to affect students' decisions to work with underserved populations," the authors write.
Examples of Associations
The researchers found, for instance, that observing microaggressions (such as minority students being subjected to offensive remarks/names or being treated with less respect than others) and students feeling that they weren't encouraged to interact with students from different cultures may result in declining interest in working in underserved populations.
"[M]ore negative fourth-year explicit racial attitudes and increased medical authoritarianism were associated with losing or maintaining no interest in providing care in an underserved area or for minority patients," they add.
Conversely, taking part in a seminar on minority health; a greater number of interactions with black students, faculty, and staff; perception that their school was committed to diversity; and a greater percentage of minority students at their school were linked with increased interest among students in working in an underserved area and caring primarily for minority patients.
The authors note that sometimes racism occurs in omission — for example a lack of emphasis in curriculum on minority health or health equity "that can potentially influence medical students' interest in working with underserved populations."
"We suggest that, within medical education, the types of courses that medical schools require and the information that they prioritize for training new physicians can critically shape students' interest in practicing in underserved areas," they write.
According to a news release, this study is the latest of more than 30 articles analyzing data from the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES), the first longitudinal survey study of the link between medical education and biases and attitudes over time.
Phelan explained in the release that the study focused on attitudes toward African Americans to limit the scope, although CHANGES assessed attitudes about other groups as well.
"I hope the study will spark change," Phelan said. "I would like to see more conversation about diversity and inclusion in curriculum and the need to make changes in medical training to minimize racism and bias."
The study was supported by the National Heart, Lung, and Blood Institute.
The authors have disclosed no relevant financial relationships.
Academic Medicine. Published online August 2019. Abstract
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