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

项目摘要/摘要： 许多研究表明，种族和少数民族不接受治疗性医疗程序。 与非西班牙裔白人的比例相同，最有力的证据表明 利用侵入性心脏手术。造成这些种族差异的原因尚不清楚，但 地理和财务准入、潜在发病率、保险状况和收入不能完全解释 不同之处。有提示性的证据表明，一个促成因素是 医生根据种族和/或性别向患者提供这些程序，而这种偏见可能是 出现在医科学生中。 这项创新的、多学科、多方法的研究将调查高血压的患病率和决定因素 老年医学科学不确定性条件下医疗决策中的种族和性别偏见 学生们。它将进一步发展关于非临床因素成为部分动力的信息 学生的医疗决策，以及发生这种决策的培训环境。在这样做的时候， 这项研究将为医学教育工作者和文化能力培训的开发者提供必要的指导 旨在减少健康的这一社会决定因素以及随之而来的种族和性别差异在#年的影响 提供健康服务。 首先将对全国范围内的对抗性医学生进行邮寄调查，以确定 这种偏见的流行使用了一组临床小插曲，在这些小插曲中，患者的种族和性别将有所不同 在样本中。“病人”种族、性别和社会经济地位对患病率的影响 将对学生的程序性推荐进行分析。 然后，将在每一所有目的地选择的14所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力。为此案服务的学校 研究将根据对调查的回应模式的摘要进行选择，并对以下学校进行抽样 研究表明，种族和性别对学生的反应有或多或少的影响。 深入访谈学生、教职工重点线人访谈，考查文化胜任力 学生课程和录取过程是将使用的一些数据收集过程 探索学生决策过程形成、加强或减少的背景。这个 调查和案例研究的结果将被用来为学校、政策制定者、 以及同行评议的科学报告和出版物。 这项研究的具体目标是制定和传播基于证据的建议，以 医学教育者和文化能力培训的开发者有兴趣减少这样的角色 在提供保健服务方面，偏见在种族和性别差异中发挥作用。

Project Summary/Abstract: 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.