Doctoral Dissertation Research: The Social Determinants of Distress, Burnout, and Program Attrition Among Students of Color on the Premedical Track

尽管西班牙裔和黑人分别占美国人口的17%和13%，但在2013年，这两个群体分别只占医学院在校生的9%和7%。虽然这一趋势的部分原因可以归因于最近一些州平权行动计划的减少，但也有人认为，由于大学校园里的学术和人际交往经历，最终使这些学生不愿意从事医学事业，潜在的少数族裔申请者数量减少了。本研究探讨社会资源（社会支持、社会网络和与网络相关的物质资源）在人际和制度层面的累积变化如何影响学生的心理困扰和倦怠体验，并导致医前耗损的种族和民族差异。现有的关于有色人种医学预科学生轨迹的研究依赖于横断面调查数据和机构记录，仅限于学生的社会人口统计学特征、SAT分数和必修课程成绩的粗略信息。尽管这些信息用于检查学术轨迹，但这些数据不足以理解人际和社会结构因素如何导致医疗前管道中的泄漏。为了确定这种下降发生在哪里以及为什么会发生，拟议的研究通过采用纵向调查设计，结合深度访谈，解决了以前的方法限制，以更全面地了解形成医疗前保留的动态和复杂的社会过程。这项研究有希望解决教育机会不平等问题，这对美国预计的医疗短缺造成了严重后果。考虑到一贯的发现，那些上医学院的少数族裔成员比他们的同龄人更有可能在服务不足的市中心地区执业，这些教育差异对预计的医疗短缺有直接的影响。

Although Hispanics and Blacks make up 17% and 13% of the U.S. population, members of these groups comprised only 9% and 7% of medical school enrollees in 2013, respectively. While a portion of this trend can be attributed to recent declines in affirmative action programs across a number of states, it has also been suggested that the potential pool of minority applicants is diminished due to academic and interpersonal experiences on college campuses that ultimately discourage these students from pursuing careers in medicine. This study interrogates how cumulative changes in social resources (social support, social networks, and network-related material resources) at both the interpersonal and institutional level influence students' experiences of psychological distress and burnout, and contribute to racial and ethnic disparities in premedical attrition. Existing research on the trajectories of premedical students of color has relied on cross-sectional survey data and institutional records limited to cursory information on students' sociodemographic characteristics, SAT scores, and grades in required coursework. Despite the utility of this information for examining academic trajectories, these data are insufficient for understanding how interpersonal and social structural factors contribute to leaks in the premedical pipeline. In order to identify where this drop off occurs and why it happens, the proposed research addresses previous methodological constraints by employing a longitudinal survey design, in tandem with in-depth interviews, to create a fuller understanding of the dynamic and complex social processes that shape premedical retention. This research holds the promise of addressing inequities in educational opportunities that pose serious consequences for projected healthcare shortages in the United States. Given the consistent finding that underrepresented minority group members who go on to medical school are significantly more likely than their peers to practice in underserved inner-city areas, these educational disparities have direct consequences for projected shortages in medical care.