Contributions to Racial Bias in Medical Student Judgement and Decision-Making

医学生判断和决策中种族偏见的贡献

• 批准号: 7737003
• 负责人: Michelle van Ryn
• 金额: $ 75.33万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7737003
• 关键词: Accounting; Area; Attitude; Behavior; Belief; Cancer Detection; Cardiovascular Diseases; Characteristics; Classification; Clinical; Collaborations; Communicable Diseases; Communication; Data; Data Element; Decision Making; Detection; Development; Diagnostic; Education; Effectiveness of Interventions; Enrollment; Evaluation; Faculty; Healthcare; Impact evaluation; Incentives; Individual; Infant Mortality; Influentials; Institute of Medicine (U.S.); Intervention; Judgment; Label; Longitudinal Studies; Measures; Mediating; Medical; Medical Education; Medical Students; Medicine; Minority; Minority Groups; Modeling; Modification; NIH Program Announcements; Online Systems; Patients; Physicians; Policies; Prevalence; Provider; Race; Randomized; Recommendation; Relative (related person); Reporting; Research; Research Project Grants; Risk; Risk Management; Sampling; Schools; Series; Socialization; Source; Specific qualifier value; Students; Survey Methodology; Surveys; System; Technology; Training; Unconscious State; Underserved Population; Work; Writing; cancer prevention; cohort; cultural competence; effective intervention; ethnic discrimination; evidence base; experience; falls; health care delivery; health disparity; improved; innovation; interest; knowledge base; longitudinal design; medical schools; multidisciplinary; prevent; programs; public health relevance; racial and ethnic; racial and ethnic disparities; racism; response; sex

DESCRIPTION (provided by applicant): The ultimate purpose of this project is to inform effective and efficient strategies intended to eliminate both implicit racial bias and the inappropriate effect of patient race on c 4th year medical students' clinical judgments and decisions. There is a huge gap in the needed evidence base. We know very little about the medical school or individual factors that increase or decrease the likelihood of implicit (automatic, unconscious) or explicit bias among graduating medical students. The impact of cultural competence training, informal norms, or school diversity on racial bias is unknown. Furthermore, the determinants of bias may be confounded in ways difficult to disentangle, lowering the utility of studies that only examine a small set of determinants. For example, an observed association between a medical school characteristic and bias may be spurious and due to individual characteristic(s) that predict both medical school choice and likelihood of racial bias. The effect of cultural competence training may be moderated by student characteristics. In response to these considerations, we propose to conduct an innovative multi-measure longitudinal study of a national sample of medical students in order to examine the impact of medical school factors, independent of individual medical student characteristics, on implicit and explicit racial bias in medical students' judgments and decisions. Specifically, we propose to enroll a random sample of 5600 medical students during their 1st year and follow them through the end of their 4th year. We will apply a rigorously developed response rate maximization strategy involving high levels of incentives. Data on individual factors will be collected using web based surveys in students' 1st and 4th year. Since there are no existing valid and comprehensive sources of the medical school factors of interest, we will use survey methodology to obtain such data from a representative sample of students who are completing their medical school education when our cohort is at the end of their second year in medical school. Racial bias will be assessed during the 1st and 4th year of medical school and include: 1) general implicit racial bias and 2) the degree to which patient race influences medical student judgments and decisions in response to written clinical vignettes in which patient race and sex will be randomly assigned and all other patient factors held constant. The impact of medical school factors on implicit racial bias in student's 4th year as well as on the degree to which patient race influences medical students' clinical judgments and decisions will be examined, independent of relevant individual student characteristics. PUBLIC HEALTH RELEVANCE: The ultimate purpose of this project is to inform effective and efficient strategies intended to eliminate both implicit racial bias and bias in clinical judgment and decisions among medical students' judgments and decisions. We propose to conduct an innovative multi-measure longitudinal study of a national sample of medical students in order to examine the impact of individual and medical school factors on implicit and explicit racial bias in medical students' judgments and decisions.

描述（由申请人提供）：本项目的最终目的是提供有效和高效的策略，旨在消除隐式种族偏见和患者种族对第四年医学生临床判断和决策的不适当影响。在所需的证据基础方面存在巨大差距。我们对医学院或个人因素知之甚少，这些因素会增加或减少即将毕业的医学生中隐性（自动、无意识）或显性偏见的可能性。文化能力培训、非正式规范或学校多样性对种族偏见的影响尚不清楚。此外，偏见的决定因素可能会以难以理清的方式混淆，降低了只检查一小部分决定因素的研究的效用。例如，观察到的医学院特征和偏见之间的关联可能是虚假的，并且由于预测医学院选择和种族偏见可能性的个体特征。文化能力训练的效果可能会受到学生特征的调节。针对这些考虑，我们建议进行一项创新的多措施纵向研究的全国样本的医学生，以检查医学院的因素，独立于个别医学生的特点，对医学生的判断和决定的内隐和外显种族偏见的影响。具体来说，我们建议在第一年随机抽取5600名医学生，并在第四年结束时跟踪他们。我们将应用严格制定的响应率最大化策略，其中涉及高水平的激励措施。在学生的第一年和第四年，将使用基于网络的调查收集个人因素的数据。由于没有现有的有效和全面的医学院校感兴趣的因素的来源，我们将使用调查方法，以获得这样的数据，从一个有代表性的样本的学生谁是完成他们的医学院教育时，我们的队列是在他们的第二年结束在医学院。将在医学院的第一年和第四年评估种族偏见，包括：1）一般隐性种族偏见和2）患者种族影响医学生对书面临床插图的判断和决定的程度，其中患者种族和性别将被随机分配，所有其他患者因素保持不变。医学院因素对学生第四年的隐性种族偏见的影响以及患者种族影响医学生临床判断和决策的程度将进行检查，独立于相关的个别学生特征。公共卫生相关性：本项目的最终目的是提供有效和高效的策略，旨在消除医学生的判断和决定中的隐性种族偏见和临床判断和决定中的偏见。我们建议进行一项创新的多措施的纵向研究，医学生的全国样本，以检查个人和医学院的因素对医学生的判断和决定的内隐和外显种族偏见的影响。