Stereotyping in medical student decision-making: presence, origins and solutions

医学生决策中的成见：存在、起源和解决方案

• 批准号: 8149882
• 负责人: ROBERT L WILLIAMS
• 金额: $ 37.37万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8149882
• 关键词: Address; Admission activity; African American; Area; Cardiac; Cardiac Catheterization Procedures; Caring; Case Study; Clinical; Communication; Confounding Factors (Epidemiology); Coronary Artery Bypass; Data; Data Collection; Decision Making; Development; Disease; Educational Curriculum; Environment; Faculty; Gender; Goals; Health; Health Services; Income; Insurance Coverage; Interview; Mails; Medical; Medical Students; Minority Groups; Morbidity - disease rate; Not Hispanic or Latino; Outcome; Patients; Pattern; Peer Review; Perception; Physician-Patient Relations; Physicians; Plant Roots; Play; Policy Maker; Prevalence; Preventive; Procedures; Process; Psychological reinforcement; Publications; Publishing; Race; Recommendation; Reporting; Research; Research Personnel; Role; Sampling; Schools; Services; Sex Bias; Socioeconomic Status; Solutions; Stereotyping; Students; Surveys; Therapeutic; Training; Trust; Uncertainty; base; coronary angioplasty; evidence base; evidence based guidelines; experience; health care delivery; health disparity; informant; innovation; interest; medical schools; mortality; multidisciplinary; programs; public health relevance; racial and ethnic; response; social health determinants

DESCRIPTION (provided by applicant): Many studies have shown that racial and ethnic minorities do not receive therapeutic medical procedures at the same rates as non-Hispanic whites, with the strongest evidence of these racial disparities in the utilization of invasive cardiac procedures. The causes of these racial disparities remain unclear, but geographic and financial access, underlying morbidity, insurance status, and income cannot fully explain the differences. There is suggestive evidence that a contributing factor is a difference in the rate at which physicians offer these procedures to patients based on race and/or gender, and that such biases may be present in medical students. This innovative, multidisciplinary, multimethod study will investigate the prevalence and determinants of racial and gender biases in medical decision-making under conditions of scientific uncertainty of senior medical students. It will further develop information about the dynamics by which non-clinical factors become part of student medical decision-making, and the training environment in which this takes place. In doing so, the study will provide essential guidance to medical educators and developers of cultural competency training who aim to reduce the impact of this social determinant of health and accompanying racial and gender disparities in health service delivery. A nationwide mail survey of senior allopathic medical students will first be conducted to determine the prevalence of such biases using a set of clinical vignettes in which the race and gender of the "patient" will vary among the sample. The influence of "patient" race, gender and socioeconomic status on the rates of procedural recommendation by the students will be analyzed. Ecological case studies will then be conducted at each of 14 purposively selected medical schools to explore the context and dynamics of formation of student medical decision-making. Schools for the case studies will be selected based on summaries of response patterns to the survey, with sampling of schools for study that demonstrate greater or lesser degrees of influence of race and gender on their students' responses. In-depth interviews of students, faculty and staff key informant interviews, examination of cultural competency and student curricula and of admission processes are some of the data collection processes that will be used to explore the context in which student decision-making processes are formed, reinforced, or reduced. The findings of the combined survey and case studies will be used to prepare reports for schools, policy makers, and peer-reviewed scientific presentations and publications. The specific objective of this study is to develop and disseminate evidence-based recommendations for medical educators and developers of cultural competency training interested in reducing the role that such biases play in racial and gender disparities in health services delivery. PUBLIC HEALTH RELEVANCE: This multidisciplinary study will investigate the prevalence and origins of racial- and gender- based biases in medical decision-making, and make evidence-based recommendations for eliminating these biases. Previous published evidence suggests this understudied social determinant of health is a contributor to health disparities experienced by many in the U.S.

描述（由申请人提供）：许多研究表明，少数种族和少数民族接受治疗性医疗程序的比例与非西班牙裔白人不同，最有力的证据表明，在侵入性心脏手术的使用方面存在种族差异。这些种族差异的原因尚不清楚，但地理和经济条件，潜在的发病率，保险状况和收入不能完全解释的差异。有提示性证据表明，一个促成因素是医生根据种族和/或性别向患者提供这些程序的比率存在差异，并且这种偏见可能存在于医学生中。 这项创新的，多学科的，多方法的研究将调查的患病率和决定因素的种族和性别偏见的医疗决策条件下的科学不确定性的高年级医学生。它将进一步发展的动态信息，其中非临床因素成为学生医疗决策的一部分，并在其中发生的培训环境。在这样做的时候，这项研究将提供必要的指导，医学教育工作者和开发人员的文化能力培训，旨在减少这种健康的社会决定因素的影响，并伴随着种族和性别差异的卫生服务提供。 首先将对高级对抗疗法医学生进行全国性的邮件调查，以确定这种偏见的流行程度，使用一组临床小插曲，其中“病人”的种族和性别在样本中各不相同。本研究将分析“病患”种族、性别及社会经济地位对学生推荐手术比率的影响。 生态案例研究将在14所有目的地选择的医学院进行，以探索学生医疗决策形成的背景和动态。将根据对调查的答复模式的总结选择进行个案研究的学校，并对种族和性别对学生答复的影响程度或大或小的学校进行抽样研究。深入采访学生，教师和工作人员的关键线人访谈，文化能力和学生课程和录取过程的检查是一些数据收集过程，将用于探索学生决策过程中形成的背景下，加强，或减少。综合调查和案例研究的结果将用于为学校、政策制定者编写报告，以及同行评审的科学报告和出版物。 本研究的具体目标是为医学教育工作者和文化能力培训开发人员制定和传播循证建议，以减少这种偏见在提供医疗服务方面的种族和性别差异中的作用。 公共卫生关系：这项多学科研究将调查医疗决策中基于种族和性别的偏见的普遍性和起源，并提出消除这些偏见的循证建议。以前发表的证据表明，这种未充分研究的健康社会决定因素是美国许多人经历的健康差异的一个因素。