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

项目概要/摘要： 许多研究表明，少数种族和少数民族得不到治疗性医疗程序， 与非西班牙裔白人的比率相同，最有力的证据表明， 使用侵入性心脏手术。这些种族差异的原因尚不清楚，但 地理和经济条件、潜在的发病率、保险状况和收入不能完全解释 差异有提示性证据表明，一个促成因素是以下比率的差异： 医生根据种族和/或性别向患者提供这些程序，这种偏见可能是 在医学生中。 这项创新的，多学科的，多方法的研究将调查的患病率和决定因素， 在科学不确定性条件下的医疗决策中的种族和性别偏见 学生它将进一步发展的动态信息，其中非临床因素成为一部分， 学生的医疗决策，并在其中发生的培训环境。这样做 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的影响， 提供保健服务。 将首先对高级对抗疗法医学生进行全国性的邮件调查，以确定 使用一组临床小插曲，其中"患者"的种族和性别将有所不同， 在样品中。"患者"种族、性别和社会经济地位对 分析学生的程序性推荐。 然后，将在14所有目的地选择的医学院中进行生态案例研究， 探索学生医疗决策形成的背景和动力。学校为例 研究将根据对调查的回应模式的总结进行选择，并对学校进行抽样调查， 这些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、教职员工关键线人访谈，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。的 综合调查和个案研究的结果将用于编写报告，供学校，决策者， 以及同行评审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， 医学教育工作者和文化能力培训的开发者有兴趣减少这种作用， 偏见在提供保健服务方面造成种族和性别差异。

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.