Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US

Curriculum reform and stereotype threat in medical education: Implications for student well-being

PURPOSE

Altering the curriculum of a program can have negative repercussions for the student experience, including peer mentorships and interclass relationships. This study investigated the effect of curriculum reform on students' emotional and social well-being in a predoctoral dental program. We explored if any of these consequences could be related to stereotype threat.

METHODS

We utilized a quasi-experimental design with two different treatments, New Curriculum Treatment (New-CT, n = 44) and Past Curriculum Treatment (Past-CT, n = 43). Quantitative data were collected through surveys to assess students' perceptions of curriculum changes and their impacts on anxiety, confidence, and clinical performance. Qualitative data were gathered via semi-structured interviews to explore personal experiences of stereotype threat and its implications on peer relationships and mentorship dynamics.

RESULTS

The findings suggest significant effects of curriculum changes on interpersonal relationships. Past-CT viewed New-CT as overconfident, while New-CT felt heightened performance pressure. Thematic and interview analyses revealed deep-rooted tensions, with New-CT feeling mistrusted and Past-CT resenting New-CT's perceived accelerated competence. Stereotype threat was identified as a key factor worsening these inter-group tensions and affecting clinical performance and relationships.

CONCLUSIONS

Curriculum changes in dental education can significantly affect students' well-being, with stereotype threat playing a critical role in these dynamics. When making changes to the structure, sequencing, or content of a program, administrators need to be aware of the potential ramifications these changes could have on students' relationships with their peers.

Racial and Ethnic Discrimination and Medical Students' Identity Formation

Importance

Investigating racial and ethnic discrimination in medical education is crucial for addressing disparities and fostering an inclusive environment.

Objective

To assess how racial and ethnic discrimination in medical school is associated with personal and professional identity formation (PPIF) by race and ethnicity.

Design, Setting, and Participants

This retrospective cross-sectional study used deidentified data on 37 610 medical students who matriculated in 2014 or 2015 and took the Association of American Medical Colleges Graduation Questionnaire (GQ) between 2016 and 2020. Statistical analysis was performed from September 1 to November 20, 2023.

Exposures

Experiences of racial and ethnic discrimination were assessed through responses to 3 GQ questions about denial of opportunities, offensive remarks or names, and lower evaluations or grades due to race or ethnicity.

Main Outcomes and Measures

Personal and professional development were measured as 2 separate outcomes using 2 GQ statements rated on a 5-point Likert scale (where 1 indicated strongly disagree and 5 indicated strongly agree): "My medical school has done a good job fostering and nurturing my development as a person" and "My medical school has done a good job fostering and nurturing my development as a physician." Variables of personal and professional development were both dichotomized.

Results

Of 37 610 medical students, 18 200 (48.4%) were female, and 19 410 (51.6%) were male; 2458 (6.5%) were African American or Black, 7801 (20.7%) were Asian, 2430 (6.5%) were Hispanic, 21 380 (56.9%) were White, 2404 (6.4%) were multiracial, and 1137 (3%) were other race or ethnicity. Most respondents attested that their medical school fostered their personal (27 272 [72.5%]) and professional (34 560 [91.9%]) development. African American or Black students reported the lowest rates of personal (1603 of 2458 [65.2%]) and professional (2182 of 2458 [88.8%]) development, and experienced lower likelihoods of personal (adjusted risk ratio [ARR], 0.89 [95% CI, 0.86-0.93]) and professional (ARR, 0.95 [95% CI, 0.94-0.97]) development than White students. Racial discrimination was inversely associated with development, with the highest PPIF rates among those never experiencing discrimination (personal, 25 089 of 33 508 [74.9%]; and professional, 31 257 of 33 508 [93.3%]). Those experiencing isolated discrimination (personal: ARR, 0.83 [95% CI, 0.80-0.87]; professional: ARR, 0.92 [95% CI, 0.91-0.95]) and recurrent discrimination (personal: ARR, 0.63 [95% CI, 0.60-0.66]; professional: ARR, 0.82 [95% CI, 0.80-0.84]) had relatively lower likelihoods of PPIF. African American or Black students experienced the highest rate of recurrent discrimination (543 of 2458 [22.1%]). No significant PPIF risk differences were found for other racial and ethnic groups underrepresented in medicine without discrimination compared with White students without discrimination, but all groups with recurrent discrimination had relatively lower PPIF risk.

Conclusions and Relevance

In this cross-sectional study of US medical students, racial and ethnic discrimination was associated with lower PPIF across all racial and ethnic groups compared with White students without such experiences. African American or Black students disproportionately faced this discrimination. Systemic changes in medical education are needed to combat discrimination and ensure equity in holistic student development.

Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.