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: 9269748
• 负责人: Michelle van Ryn
• 金额: $ 15.11万
• 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/9269748
• 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; Health; 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; explicit bias; health care disparity; implicit bias; improved; insight; medical schools; mortality; novel; patient population; point of care; prevent; programs; racial bias; racial disparity; racial health disparity; response; role model; sexual minority; social; unconscious bias

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(由申请者提供)：这项研究是一项研究计划的一部分，旨在评估和提高医生培训在多大程度上促进医生为所有患者提供同等高质量和以患者为中心的护理的能力，而不考虑他们的种族或民族、体型或性取向。医生的行为和决策是医疗保健中广泛记录的种族差异的关键因素。尽管有证据表明，医生有动机为所有患者提供高质量的护理，但隐性(无意识)偏见仍可能微妙和间接地表达出来，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，因为它们通常是无意识的，可能会对治疗和护理产生系统性但基本上是无意的影响。许多医学院和住院医师培训项目都实施了课程，希望防止受训者出现种族和其他偏见，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式规范和价值观相互作用知之甚少。这项研究将通过评估住院特征对3650名毕业医学生的大型纵向队列中内隐和外显偏见的影响来解决这些差距，该特征独立于个体学生和医学院因素。此次更新建立在通过对参加医学生变化研究的医学生(1 R01 HL085631，在医学生判断和决策中的种族偏见的贡献者)的重复评估中收集的丰富的多测量数据的基础上，通过住院医师培训跟踪队列。在改变中，我们发现，在种族偏见、负面角色建模、种族间接触和多样化环境方面的培训都预测了医学院第一到第四年之间隐性种族偏见的变化。这些影响在医学院之外会持续到什么程度还不得而知。我们还发现，医学生对肥胖和性少数群体的负面内隐偏见水平很高，这种偏见独立于他们的有意识(外显)态度，并与他们的有意识(外显)态度相反。本研究采用纵向重复测量设计，独立地并结合个人和医学院因素，评估住院特征对新医生的影响：1)种族、肥胖和性取向偏见，2)已被证明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，这是第一次对这一范围进行纵向研究，调查受训医生的内隐偏见以及可能直接影响他们将提供的医疗服务质量的相关认知和行为因素的变化。了解在整个医疗培训中塑造新医生社会信念和态度的因素，特别是 在为实践做准备的最后阶段，将为新的干预措施提供独特的信息，以促进对历史上遭受污名的群体进行更有效的保健。