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

描述（由申请人提供）：许多研究表明，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，在使用有创心脏手术方面存在种族差异的最有力证据。造成这些种族差异的原因尚不清楚，但地理和经济状况、潜在发病率、保险状况和收入不能完全解释这些差异。有暗示性证据表明，一个促成因素是医生根据种族和/或性别向患者提供这些手术的比率存在差异，这种偏见可能存在于医科学生中。本研究旨在探讨在科学不确定的情况下，高年级医学生在医疗决策中存在的种族和性别偏见及其决定因素。它将进一步发展有关非临床因素成为学生医疗决策一部分的动态信息，以及发生这种情况的培训环境。在此过程中，这项研究将为医学教育工作者和文化能力培训的开发人员提供必要的指导，他们的目标是减少这一健康的社会决定因素的影响以及在提供保健服务方面随之而来的种族和性别差异。一项针对对抗疗法医学院高年级学生的全国性邮件调查将首先进行，以确定这种偏见的普遍程度，使用一组临床小插曲，其中“病人”的种族和性别将在样本中有所不同。“病人”的种族、性别和社会经济地位对学生程序推荐率的影响将被分析。然后，将在14所有目的选择的医学院进行生态案例研究，以探索学生医疗决策形成的背景和动态。案例研究的学校将根据对调查的反应模式的摘要来选择，并对种族和性别对学生的回答或多或少地产生影响的学校进行抽样研究。对学生、教职员工的深入访谈、对文化能力、学生课程和录取过程的考察是一些数据收集过程，这些过程将用于探索学生决策过程形成、加强或减少的背景。综合调查和案例研究的结果将用于为学校、政策制定者和同行评审的科学报告和出版物准备报告。本研究的具体目标是为医学教育者和文化能力培训的开发者制定和传播基于证据的建议，这些建议对减少这种偏见在卫生服务提供中的种族和性别差异中所起的作用感兴趣。

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.