The Impact of Residency Factors on Racial, Size & LGBT Bias in Physician Trainees

居住地因素对种族、体型的影响

• 批准号: 8817801
• 负责人: Michelle van Ryn
• 金额: $ 81.2万
• 依托单位: MAYO CLINIC ROCHESTER
• 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 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8817801
• 关键词: Address; Affect; Anxiety; Attitude; Authoritarianism; Behavior; Behavioral; Belief; Caring; Characteristics; Climate; Clinical; Cognitive; Conscious; Data; Data Set; Decision Making; Educational Curriculum; Empathy; Enrollment; Ethnic Origin; Evaluation; Goals; Healthcare; Implicit Association Test; Individual; Intervention; Judgment; Left; Lesbian Gay Bisexual Transgender; Longitudinal Studies; Measures; Medical; Medical Residency; Medical Students; Mental Health; Minority; Morbidity - disease rate; Motivation; Obesity; Patient-Centered Care; Patients; Personal Satisfaction; Physicians; Prejudice; Quality of Care; Race; Recommendation; Research; Residencies; Role; Sampling; Sex Orientation; Shapes; Staging; Stress; Students; Training; Training Programs; Unconscious State; Underserved Population; Vulnerable Populations; Work; cohort; design; effective intervention; evidence base; experience; improved; insight; medical schools; mortality; novel; patient population; point of care; prevent; programs; public health relevance; racial disparity; response; role model; sexual minority; social

DESCRIPTION (provided by applicant): This study is part of a program of research intended to evaluate and improve the degree to which physician training promotes physicians' ability to provide equally high quality and patient-centered care to all patients regardless of their race or ethnicity, size, or sexual orientation. Physician behavior and decision-making is a key contributor to the extensively documented racial disparities in health care. Despite evidence that physicians are motivated to provide high quality care to all of their patients, implicit (unconscious) biases may still be expressed subtly and indirectly, for example in physicians' assumptions about patient characteristics that affect treatment recommendations. These implicit biases, because they are typically unconscious, can have a systematic but largely unintentional impact on treatment and care. Many medical school and residency training programs have implemented curricula in hopes of preventing racial and other biases in trainees but approaches vary widely and have received little evaluation. Furthermore, little is known about how formal training interacts with informal norms and values. This study will address these gaps by assessing the impact of residency characteristics, independent of individual student and medical school factors, on implicit and explicit bias in a large longitudinal cohort of 3650 graduating medical students. This renewal builds on rich multi-measure data collected through repeated assessment of medical students enrolled in the Medical Student CHANGES Study (1 R01 HL085631, Contributors to Racial Bias in Medical Student Judgment and Decision-Making) by following the cohort through residency training. In CHANGES we found that training in racial bias, negative role-modelling, interracial contact, and diversity climate all predicted change in implicit racial bias between the 1st and 4th years of medical school. The degree to which these effects persist beyond medical school is unknown. We also found that medical students held high levels of negative implicit bias towards obese and sexual minority individuals that persisted independently of and in contrast to their conscious (explicit) attitudes. This study uses a longitudinal repeated measures design to assess the impact of residency characteristics, independently and in combination with individual and medical school factors, on new physicians': 1) racial, obesity and sexual orientation biases and 2) attitudes and behaviors that have been shown to protect from, or exacerbate, the impact of bias on behavior and decision-making. To our knowledge, this is the first longitudinal study of this scope that investigates changes in physician trainees' implicit biases and related cognitive and behavioral factors that can directly influence the quality of medical care they will provide. Understanding the factors that shape new physicians' social beliefs and attitudes across their medical training, particularly in the final stages in which they prepare for practice, will provide unique information for new interventions that can promote more effective health care for historically stigmatized groups.

描述（由申请人提供）：本研究是一项研究计划的一部分，旨在评估和提高医生培训促进医生向所有患者提供同等高质量和以患者为中心的护理的能力的程度，无论其种族或民族、体型或性取向如何。医生的行为和决策是广泛记录的医疗保健种族差异的关键因素。尽管有证据表明，医生有动力为所有患者提供高质量的护理，但隐性（无意识）偏见仍可能以微妙和间接的方式表达，例如医生对影响治疗建议的患者特征的假设。这些隐含的偏见，因为他们通常是无意识的，可以有一个系统的，但在很大程度上是无意的影响治疗和护理。许多医学院和住院医师培训计划都实施了课程，希望防止学员中的种族和其他偏见，但方法差异很大，几乎没有得到评估。此外，人们对正规培训如何与非正规规范和价值观相互作用知之甚少。本研究将通过评估住院医师特征的影响来解决这些差距，独立于个别学生和医学院的因素，对3650名毕业医学生的大型纵向队列中的内隐和外显偏见。此次更新建立在丰富的多指标数据的基础上，这些数据是通过对参加医学生变化研究（1 R 01 HL 085631，医学生判断和决策中种族偏见的贡献者）的医学生进行重复评估，跟踪队列进行住院医师培训而收集的。在《变化》中，我们发现种族偏见、负面角色塑造、种族间接触和多样性气候方面的培训都预测了医学院第一年和第四年之间内隐种族偏见的变化。这些影响在医学院之外持续的程度尚不清楚。我们还发现，医学生对肥胖和性少数个体持有高水平的负面内隐偏见，这种偏见独立于他们的意识（外显）态度，并与之形成对比。本研究采用纵向重复测量设计来评估住院医师特征的影响，独立地并结合个人和医学院因素，对新医生的影响：1）种族，肥胖和性取向偏见，2）已被证明可以保护或加剧偏见对行为和决策的影响的态度和行为。据我们所知，这是第一个纵向研究这一范围，调查医生实习生的内隐偏见和相关的认知和行为因素，可以直接影响他们将提供的医疗服务的质量的变化。了解塑造新医生的社会信仰和态度的因素，特别是在他们的医疗培训， 在他们准备实践的最后阶段，将为新的干预措施提供独特的信息，这些干预措施可以促进对历史上被污名化的群体提供更有效的医疗保健。