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: 9644813
• 负责人: Michelle van Ryn
• 金额: $ 83.9万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 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/9644813
• 关键词: Impact; Residency; Factors; Racial; Size

There is overwhelming evidence of racial disparities in health care and mounting evidence of disparities for other traditionally disadvantaged or stigmatized groups. Physician behavior and decision-making are documented contributors to disparities in care. Studies examining why well-intentioned and egalitarian physicians' provide unequal care point to the role of implicit (automatic, unconscious) biases, which have been shown to affect physicians' clinical decision-making, interpersonal processes of care, and to directly affect patient trust and subsequent adherence. Furthermore, medical students and physicians have been found to have high levels of implicit bias towards sexual minority and obese individuals that are likely to contribute to documented disparities in care for these groups. The proposed renewal builds on an unprecedented longitudinal study involving a rich dataset collected from a cohort of over 3959 medical students in their 1st and 4th year of medical school who were enrolled in the Medical Student CHANGES Study (1 R01 HL085631, Contributors to Racial Bias in Medical Student Judgment and Decision-Making). In Medical Student CHANGES we found that specific activities in the formal curricula, 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 proposed renewal uses a longitudinal repeated measures design to assess the impact of residency experiences among this cohort, independently and in combination with individual and medical school factors, on: 1) racial, obesity and sexual orientation biases and 2) attitudes and behavior that have been shown to protect from, or exacerbate, the impact of bias on clinical behavior and decision-making. The proposed renewal will serve as a much-needed and entirely novel examination of the effect of residency training, climate and informal and formal norms on racial, sexual orientation, and obesity bias in new physicians. In addition to adding to our understanding of how residency affects bias, it will provide insight into the way residency influences new physician behavior shown to reduce the impact of biases on behavior and decision-making. Last, it will allow for disentangling the effect of individual, medical school, and residency factors so that more effective interventions can be developed. This renewal proposal 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 diverse patients. To our knowledge, this is the first longitudinal study of this scope that investigates changes in medical trainees' social attitudes and experiences that can directly influence the quality of medical care they will provide to members of historically stigmatized groups. Understanding the factors that shape medical physician trainees' beliefs and attitudes across their medical training will provide unique information for new interventions that can promote more effective healthcare for traditionally disadvantaged or stigmatized groups.

有压倒性的证据表明，在医疗保健方面存在种族差异， 其他传统上处于不利地位或受歧视的群体。医生的行为和决策是 记录在案的造成护理不平等的因素。研究探讨为什么善意和平等主义 医生提供的不平等护理指出了内隐（自动的，无意识的）偏见的作用， 显示影响医生的临床决策，人际护理过程，并直接影响 患者的信任和随后的依从性。此外，医学生和医生被发现， 对性少数和肥胖个体有很高的内隐偏见，这可能会导致 在照顾这些群体方面存在的差距。拟议的更新建立在前所未有的 一项纵向研究，涉及从超过3959名医学生的队列中收集的丰富数据集， 参加医学生变化研究的医学院4年级学生（1 R01 HL 085631， 医学生判断和决策中的种族偏见的贡献者）。医学生 我们发现，正式课程中的具体活动，负面的角色塑造，种族间的接触， 和多样性气候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。 建议的更新使用纵向重复测量设计来评估居住的影响 在这个队列中的经验，独立地和与个人和医学院因素相结合， 关于：1）种族，肥胖和性取向偏见，2）态度和行为，已被证明， 避免或加剧偏倚对临床行为和决策的影响。拟议 更新将作为一个急需的和完全新颖的检查住院医师培训的影响，气候 以及新医生中关于种族、性取向和肥胖偏见的非正式和正式规范。除了 增加了我们对居住权如何影响偏见的理解，它将提供对居住权如何影响偏见的洞察力。 影响新的医生行为，以减少偏见对行为和决策的影响。 最后，它将允许解开个人，医学院和居住地因素的影响，以便更多的 可以制定有效的干预措施。这项更新建议是一项研究计划的一部分， 评估和提高医生培训促进医生平等提供服务的能力的程度 为不同的患者提供高质量和以患者为中心的护理。据我们所知，这是第一个纵向研究， 调查医学实习生的社会态度和经验的变化， 影响到他们向历史上被污名化的群体成员提供的医疗服务的质量。 了解塑造医学实习生在医疗过程中的信念和态度的因素 培训将为新的干预措施提供独特的信息，以促进更有效的医疗保健， 传统上处于不利地位或受歧视的群体。