Experiences of Discrimination, Institutional Responses to Seminal Race Events, and Depressive Symptoms in Black U.S. Medical Students

Exploring empathy and patient-centered communication behaviors of third-year medical students during a clinical skills examination

A previous study of third-year medical students' empathy during a clinical skills assessment found that SPs rated female students higher than males, and male Black/African-Americans received the lowest empathy scores. Our objective was to analyze students' patient-centered communication behaviors (PCCBs) to better understand those reported gender and racial/ethnic differences in empathy scores.

METHODS

We examined 63 videos from the parent study, using discourse and content analysis to identify PCCBs during standardized patient (SP) encounters. Then, we determined which PCCBs significantly correlated with SP empathy ratings. Finally, we examined whether those significant PCCBs differed across third-year medical students' gender and race/ethnicity.

RESULTS

We identified 18 PCCBs, six of which significantly correlated with SP empathy ratings. Generally, women tended to use patient-centered communication than men, while Black/African American men used less than Asian/Pacific Islander or white men.

CONCLUSION

In this exploratory, multiple methods study, we analyzed student discourse to better understand the reported gender and racial/ethnic differences in SP empathy scores. We found suggestions of gender and racial differences in behaviors related to patient-centered communication that need to be confirmed in larger, better-powered studies.

PRACTICE IMPLICATIONS

If our findings are corroborated, understanding gender and race/ethnicity differences in PCCBs may help medical educators teach students patient-centered communication (PCC) in a more diverse, culturally situated way. Beneficial actions would include developing faculty to teach PCC with a multi-cultural emphasis and recruiting more minority faculty in our medical schools to model effective communication and empathy skills. In addition, the PCCBs we identified through discourse analysis in this study can provide educators with a tool for teaching doctor-patient communication. Educators can review students' video encounters to provide specific and actionable feedback to promote PCC and empathy.

From othering to belonging: a framework for DEI history-telling and strategising

The medical profession in the USA is-and has long been-a segregated workforce. Currently, just 5.0% of all US physicians are black. Understanding the origins and mechanisms of this disparity is essential to creating a future where black healing and healers are supported by our medical system. In pursuit of this future, this article offers 'othering' and 'belonging' as frames of analysis and intervention for diversity and equity initiatives.Building on previous historical studies of racism in medicine, this project reveals how the figure of the 'American physician' was created through exclusionary/othering tactics. In part 1, we analyse antebellum historical sources to demonstrate the role of medicine in creating and promulgating racial categories and hierarchies. Next, in part 2, we explore the historical conditions that produced the American physician as a significant professional identity by analysing texts by the American Medical Association and affiliated state medical societies. Then, we turn towards solutions in part 3. To redress inequities produced by othering, particularly the continued exclusion of black people from the medical profession, we argue that medical leaders should cultivate a professional culture of belonging. As we will explain, belonging goes beyond tolerating and respecting difference; it entails shared culture, equal rights and inclusive structures.

Changing the Approach in Supporting and Advancing Underrepresented in Medicine (UIM) Medical Students

Introduction

Research has shown the importance of diversity in improving patient care. Medical students from backgrounds underrepresented in medicine (UIM) face unique challenges, including minority tax, stereotype threat, and expectations to be the sole representative of their identity group. Mentors must be aware of these challenges and develop skills to address them.

Methods

We designed a 90-minute workshop about the challenges UIM students encounter in medical school and best practices in mentorship. Target audience and facilitators were undergraduate medical educators. Three videos and questions for case-based facilitated small-group discussion with medical school faculty and administrators were included. Using a retrospective pre-post design, we elicited participants' confidence level in recognizing and addressing issues UIM students may experience and plans to apply skills gained in the workshop.

Results

Workshop participants (N = 57) reported a mean increase in confidence rating of 20-26 points out of 100 for recognizing, identifying, and applying skills related to optimal UIM mentorship (mean confidence: 53-60 preworkshop, 79-81 postworkshop). Participants also reported a mean of 82 in readiness to apply skills learned. Participants rated the workshop a 4.6 in overall helpfulness on a 5-point Likert scale (1 = not helpful, 5 = extremely helpful).

Discussion

Health care professionals working with UIM medical students have an essential role in mentorship and support. This workshop provides a structured forum to discuss challenges and build awareness, comfort, and skills regarding engaging in meaningful discussions about race and the experiences of medical students, even when identities are incongruent.

Burnout, Exhaustion, Experiences of Discrimination, and Stress Among Underrepresented and First-Generation College Students in Graduate Health Profession Education

OBJECTIVES

Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: (1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; (2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCSs], a member of an underrepresented minority [URM] group, or both); and (3) highlight strategies and solutions to alleviate these challenges identified by students.

METHODS

Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants' responses to open-ended questions.

RESULTS

There were 611 individuals who completed all survey questions. FGCSs were significantly more likely than non-FGCSs to report exhaustion (adjusted odds ratio [aOR]: 1.50; 95% CI = 1.04-2.16), family stress (aOR: 3.11; 95% CI = 2.13-4.55), and financial stress (aOR: 1.74; 95% CI = 1.21-2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty.

CONCLUSION

Findings from this study are consistent with literature that FGCSs experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study's findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCSs.

IMPACT

Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCSs throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity.

How to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box

We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. Diversity, equity, and inclusion (DEI; also referred to as EDI) and antiracism are key parts of patient care and medical education as they empower health professionals to be advocates for their patients, leading to better health care outcomes and more culturally and socially humble health care professionals. The Liaison Committee on Medical Education has set forth standards to include structural competency and other equity principles in the medical curriculum, but medical schools are still struggling with how to specifically do so. Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts.

A Narrative Review of Key Studies in Medical Education in 2022: Applying the Current Literature to Educational Practice and Scholarship

The expectation of every academic pediatrician is to stay updated on current evidence in their field; this is especially true of pediatric clinician educators who are training the next generation of pediatricians. Since 2016, select members of the Academic Pediatric Association Education Committee have curated educational research articles in order to distill the increasing volume of research related to medical education. The purpose of this narrative review is to summarize 14 articles published in 2022 related to medical education that may impact the work of pediatric clinician educators and educational leadership. These articles are organized into 6 overarching domains: selection and recruitment, promoting learner growth and development, learning environment and wellness, curriculum development, assessment, and educator development.

The Impacts of Engagement in the Latino Medical Student Association

Importance

The Latino Medical Student Association (LMSA) is a student-run national organization founded in 1972 dedicated to recruiting and retaining members enrolled in health professions programs through academic and social support activities. This study investigates the career impact of member participation in LMSA.

Objective

To determine if engagement in LMSA at the individual and school levels contributes to retention, success, and commitment to underserved communities.

Design

A voluntary online retrospective 18-question survey sent to LMSA-member medical students in the United States and Puerto Rico from the graduating classes of 2016-2021.

Setting

Students in medical schools in the United States and Puerto Rico.

Main Outcomes and Measures

There were 18 survey questions. A total of 112 anonymous responses were collected from March 2021 to September 2021. The survey queried levels of engagement with the LMSA and agreement on questions related to support, belonging, and career development.

Results

There is a positive relationship between level of engagement in the LMSA and social belonging, peer support, career networking, community engagement, and career commitment to serve Latinx communities. These positive outcomes were enhanced for respondents reporting strong support for their respective school-based LMSA chapters. We did not find a significant relationship between participation in the LMSA and research experiences during medical school.

Conclusions and Relevance

Participation in the LMSA is associated with positive individual support and career outcomes for members. Supporting the LMSA as a national organization and within school-based chapters can increase support for Latinx trainees and enhance career outcomes.