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Rattani A, Mian Z, Farahani S, Ridge M, Uzamere T, Bajwa M. A systematic review of barriers to pursuing careers in medicine among Black premedical students. J Natl Med Assoc 2024; 116:95-118. [PMID: 38267334 DOI: 10.1016/j.jnma.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/26/2023] [Accepted: 09/30/2023] [Indexed: 01/26/2024]
Abstract
Among the various etiologies of the exclusion of Black male physicians from the healthcare workforce, it is critical to identify and examine the barriers in their trajectory. Given that most medical school matriculants graduate and pursue residency training, medical school admission has been identified as the primary impediment to a career in medicine. Thus, this work aims to identify barriers in the journey of primarily Black, and secondarily underrepresented minority, premedical students. A systematic review of the medical literature was conducted for articles pertaining to the undergraduate/premedical period, Black experiences, and the medical school application process. The search yielded 5336 results, and 13 articles were included. Most papers corroborated common barriers, such as financial/socioeconomic burdens, lack of access to preparatory materials and academic enrichment programs, lack of exposure to the medical field, poor mentorship/advising experiences, systemic and interpersonal racism, and limited support systems. Common facilitators of interest and interventions included increasing academic enrichment programs, improving mentorship and career guidance quality and availability, and improving access to and availability of resources as well as exposure opportunities. No article explicitly discussed addressing racism. There is a dearth of studies exploring the premedical stage-the penultimate point of entry into medicine. Though interest in becoming a physician may be present, multiple and disparate impediments restrict Black men's participation in medicine. Addressing the barriers Black and underrepresented minority premedical students face requires an awareness of how multiple systems work together to discriminate and restrict access to careers in medicine beyond the traditional pipeline understanding.
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Affiliation(s)
- Abbas Rattani
- Department of Radiation Oncology, Tufts Medical Center, 800 Washington St., Boston, MA 02111, United States of America.
| | - Zoha Mian
- University of Louisville School of Medicine, A Building, Suite 110, 500 S. Preston Street, Louisville, KY 40204, United States of America
| | | | - Margaret Ridge
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, OH, 45229, United States of America
| | - Theodore Uzamere
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite W6104, Houston, TX, 77030, United States of America
| | - Moazzum Bajwa
- Department of Family Medicine at the University of California Riverside, 900 University Avenue Riverside, CA, 92521, United States of America
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Zhang D, Li G, Shi L, Martin E, Chen Z, Li J, Chen L, Li Y, Wen M, Chen B, Li H, Su D, Han X. Association between racial discrimination and delayed or forgone care amid the COVID-19 pandemic. Prev Med 2022; 162:107153. [PMID: 35810933 PMCID: PMC9259552 DOI: 10.1016/j.ypmed.2022.107153] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/17/2022] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
Racial discrimination has intensified in the U.S. during the COVID-19 pandemic, but how it disrupted healthcare is largely unknown. This study investigates the association of racial discrimination with delaying or forgoing care during the pandemic based on data from a nationally representative survey, the Health, Ethnicity and Pandemic (HEAP) study (n = 2552) conducted in October 2020 with Asians, Hispanics and non-Hispanic Blacks oversampled. Racial discrimination during the pandemic was assessed in three domains: experienced racial discrimination, race-related cyberbullying, and Coronavirus racial bias beliefs. Respondents answered whether they had delayed or forgone any type of healthcare due to the pandemic. Overall, 63.7% of respondents reported delaying or forgoing any healthcare during the pandemic. About 20.3% East/Southeast Asians, 18.6% non-Hispanic Blacks and 15.9% Hispanics reported experiences of racial discrimination, compared with 2.8% of non-Hispanic Whites. Experienced racial discrimination was associated with delaying/forgoing care among non-Hispanic Blacks (Adjusted odds ratios[AOR] = 4.58, 95% confidence interval[CI]: 2.22-9.45), Hispanics (AOR = 3.88, 95%CI: 1.51-9.98), and East/Southeast Asians (AOR = 2.14, 95%CI: 1.22-3.77). Experiencing race-related cyberbullying was significantly associated with delaying/forgoing care among non-Hispanic Blacks (AOR = 1.34, 95%CI: 1.02-1.77) and East/Southeast Asians (AOR = 1.51, 95%CI: 1.19-1.90). Coronavirus racial bias was significantly associated with delaying/forgoing care among East/Southeast Asians (AOR = 1.55, 95%CI: 1.16-2.07). The three domains of racial discrimination were consistently associated with delayed or forgone health care among East/Southeast Asians during the COVID-19 pandemic; some of the associations were also seen among non-Hispanic Blacks and Hispanics. These results demonstrate that addressing racism is important for reducing disparities in healthcare delivery during the pandemic and beyond.
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Affiliation(s)
- Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, United States of America
| | - Gang Li
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Emily Martin
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, UT, United States of America
| | - Baojiang Chen
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Hongmei Li
- Department of Media, Journalism and Film, Miami University, Oxford, OH, United States of America
| | - Dejun Su
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States of America.
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