The ultimate purpose of this project is to inform effective and efficient strategies intended to eliminate both implicit racial bias and the inappropriate effect of patient race on c 4th year medical students'clinical judgments and decisions. There is a huge gap in the needed evidence base. We know very little about the medical school or individual factors that increase or decrease the likelihood of implicit (automatic, unconscious) or explicit bias among graduating medical students. The impact of cultural competence training, informal norms, or school diversity on racial bias is unknown. Furthermore, the determinants of bias may be confounded in ways difficult to disentangle, lowering the utility of studies that only examine a small set of determinants. For example, an observed association between a medical school characteristic and bias may be spurious and due to individual characteristic(s) that predict both medical school choice and likelihood of racial bias. The effect of cultural competence training may be moderated by student characteristics. In response to these considerations, we propose to conduct an innovative multi-measure longitudinal study of a national sample of medical students in order to examine the impact of medical school factors, independent of individual medical student characteristics, on implicit and explicit racial bias in medical students'judgments and decisions. Specifically, we propose to enroll a random sample of 5600 medical students during their 1st year and follow them through the end of their 4th year. We will apply a rigorously developed response rate maximization strategy involving high levels of incentives. Data on individual factors will be collected using web based surveys in students'1st and 4th year. Since there are no existing valid and comprehensive sources of the medical school factors of interest, we will use survey methodology to obtain such data from a representative sample of students who are completing their medical school education when our cohort is at the end of their second year in medical school. Racial bias will be assessed during the 1st and 4th year of medical school and include: 1) general implicit racial bias and 2) the degree to which patient race influences medical student judgments and decisions in response to written clinical vignettes in which patient race and sex will be randomly assigned and all other patient factors held constant. The impact of medical school factors on implicit racial bias in student's 4th year as well as on the degree to which patient race influences medical students'clinical judgments and decisions will be examined, independent of relevant individual student characteristics.

Public Health Relevance

The ultimate purpose of this project is to inform effective and efficient strategies intended to eliminate both implicit racial bias and bias in clinical judgment and decisions among medical students'judgments and decisions. We propose to conduct an innovative multi-measure longitudinal study of a national sample of medical students in order to examine the impact of individual and medical school factors on implicit and explicit racial bias in medical students'judgments and decisions.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
7R01HL085631-05
Application #
8598492
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Fine, Larry
Project Start
2009-09-01
Project End
2014-11-30
Budget Start
2013-12-01
Budget End
2014-11-30
Support Year
5
Fiscal Year
2014
Total Cost
$628,865
Indirect Cost
$125,430
Name
Mayo Clinic, Rochester
Department
Type
DUNS #
006471700
City
Rochester
State
MN
Country
United States
Zip Code
55905
Burgess, Diana J; Burke, Sara E; Cunningham, Brooke A et al. (2016) Medical students' learning orientation regarding interracial interactions affects preparedness to care for minority patients: a report from Medical Student CHANGES. BMC Med Educ 16:254
Hardeman, Rachel R; Przedworski, Julia M; Burke, Sara et al. (2016) Association Between Perceived Medical School Diversity Climate and Change in Depressive Symptoms Among Medical Students: A Report from the Medical Student CHANGE Study. J Natl Med Assoc 108:225-235
Burke, Sara E; Dovidio, John F; Przedworski, Julia M et al. (2016) In Reply to Williams. Acad Med 91:163-4
Hardeman, Rachel R; Perry, Sylvia P; Phelan, Sean M et al. (2016) Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 3:250-8
Perry, Sylvia P; Hardeman, Rachel; Burke, Sara E et al. (2016) The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 3:519-26
Przedworski, Julia M; Dovidio, John F; Hardeman, Rachel R et al. (2015) A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From the Medical Student CHANGE Study. Acad Med 90:652-9
Phelan, Sean M; Burgess, Diana J; Puhl, Rebecca et al. (2015) The Adverse Effect of Weight Stigma on the Well-Being of Medical Students with Overweight or Obesity: Findings from a National Survey. J Gen Intern Med 30:1251-8
Phelan, Sean M; Puhl, Rebecca M; Burke, Sara E et al. (2015) The mixed impact of medical school on medical students' implicit and explicit weight bias. Med Educ 49:983-92
Burke, Sara E; Dovidio, John F; Przedworski, Julia M et al. (2015) Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual First-Year Medical Students? A Report From the Medical Student CHANGE Study. Acad Med 90:645-51
Phelan, Sean M; Burgess, Diana J; Burke, Sara E et al. (2015) Beliefs about the causes of obesity in a national sample of 4th year medical students. Patient Educ Couns 98:1446-9

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