Dovidio, John F.

AbstractObjectiveTo examine the experience of interracial anxiety among health professionals and how it may affect the quality of their interactions with patients from racially marginalized populations. We explored the influence of prior interracial exposure—specifically through childhood neighborhoods, college student bodies, and friend groups—on interracial anxiety among medical students and residents. We also examined whether levels of interracial anxiety change from medical school through residency.Data SourceWeb‐based longitudinal survey data from the Medical Student Cognitive Habits and Growth Evaluation Study.Study DesignWe used a retrospective longitudinal design with four observations for each trainee. The study population consisted of non‐Black US medical trainees surveyed in their 1st and 4th years of medical school and 2nd and 3rd years of residency. Mixed effects longitudinal models were used to assess predictors of interracial anxiety and assess changes in interracial anxiety scores over time.Principal FindingsIn total, 3155 non‐Black medical trainees were followed for 7 years. Seventy‐eight percent grew up in predominantly White neighborhoods. Living in predominantly White neighborhoods and having less racially diverse friends were associated with higher levels of interracial anxiety among medical trainees. Trainees' interracial anxiety scores did not substantially change over time; interracial anxiety was highest in the 1st year of medical school, lowest in the 4th year, and increased slightly during residency.ConclusionsNeighborhood and friend group composition had independent effects on interracial anxiety, indicating that premedical racial socialization may affect medical trainees' preparedness to interact effectively with diverse patient populations. Additionally, the lack of substantial change in interracial anxiety throughout medical training suggests the importance of providing curricular tools and structure (e.g., instituting interracial cooperative learning activities) to foster the development of healthy interracial relationships.

AbstractEnvironments that are hostile to one or more marginalized groups are known to have a negative effect on the mental health and well‐being of both targets and observers. Anti‐fat attitudes have been well documented in medical education, including the use of derogatory humor and discriminatory treatment toward higher‐weight patients. However, to date, it is not known what effect observing weight stigma and discrimination during medical school has on medical students’ psychological health and wellbeing, sense of belonging, and medical school burnout. The present study surveyed a total of 3994 students enrolled across 49 US medical schools at the start of their first year and at the end of their fourth year. Participants reported the frequency with which they had observed stigmatizing and discriminatory behaviors targeted at both higher‐weight patients and higher‐weight students during their four years of medical school. Observed weight stigma was prevalent, and was associated with worse psychological and general health, reduced medical school belonging and increased medical school burnout. The indirect effects of observed weight stigma on medical school burnout, via belonging, psychological health, and general health, were statistically significant in the sample as a whole, but were more pronounced in higher‐weight students. This effect may be explained, in part, by the relationship between observed stigma and medical school belonging. Higher levels of observed stigma were associated with reduced feelings of belonging in higher‐weight but not normative‐weight students. Top‐down institutional culture change is needed to rectify this situation, which is detrimental to both students and patients.

Although scholars have long studied circumstances that shape prejudice, inquiry into factors associated with long-term prejudice reduction has been more limited. Using a 6-year longitudinal study of non-Black physicians in training ( N = 3,134), we examined the effect of three medical-school factors—interracial contact, medical-school environment, and diversity training—on explicit and implicit racial bias measured during medical residency. When accounting for all three factors, previous contact, and baseline bias, we found that quality of contact continued to predict lower explicit and implicit bias, although the effects were very small. Racial climate, modeling of bias, and hours of diversity training in medical school were not consistently related to less explicit or implicit bias during residency. These results highlight the benefits of interracial contact during an impactful experience such as medical school. Ultimately, professional institutions can play a role in reducing anti-Black bias by encouraging more frequent, and especially more favorable, interracial contact.

Purpose The purpose of this study was to examine the relationship between manifestations of racism in medical school and subsequent changes in graduating medical students’ intentions to practice in underserved or minority communities, compared with their attitudes and intentions at matriculation. Method The authors used repeated-measures data from a longitudinal study of 3,756 students at 49 U.S. medical schools that were collected from 2010 to 2014. They conducted generalized linear mixed models to estimate whether manifestations of racism in school curricula/policies, school culture/climate, or student attitudes/behaviors predicted first- to fourth-year changes in students’ intentions to practice in underserved communities or primarily with minority populations. Analyses were stratified by students’ practice intentions (no/undecided/yes) at matriculation. Results Students’ more negative explicit racial attitudes were associated with decreased intention to practice with underserved or minority populations at graduation. Service learning experiences and a curriculum focused on improving minority health were associated with increased intention to practice in underserved communities. A curriculum focused on minority health/disparities, students’ perceived skill at developing relationships with minority patients, the proportion of minority students at the school, and the perception of a tense interracial environment were all associated with increased intention to care for minority patients. Conclusions This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students’ decisions to provide care in high-need communities. Strategies to identify and eliminate structural racism and its manifestations in medical school are needed.

SummaryThis study aimed to identify factors associated with high obesity care self‐competence among US medical students. The authors performed a cross‐sectional analysis of 2014 survey data on fourth year medical students collected online as part of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES). Independent variables included quality and quantity of interaction with patients and peers with obesity; hours of communication and partnership skills training; negative remarks against patients with obesity by supervising physicians, and witnessed discrimination against patients with obesity. The dependent variable was self‐competence in providing obesity care. Of 5823 students invited to participate, 3689 (63%) responded and were included in our analyses. Most students were white (65%), half were women and 42% had high self‐competence in caring for patients with obesity. Factors associated with high self‐competence included increased interaction with peers with obesity (39% vs. 49%, P < 0.001) and increased partnership skills training (32% vs. 61%, P < 0.001). Increased partnership skills training and quantity of interactions with peers with obesity were associated with high student self‐competence in providing obesity‐related care to patients. Medical schools might consider increasing partnership skills training to improve students’ preparedness and skill in performing obesity‐related care.

Purpose To determine baseline individual and school-related factors associated with increased risk of developing depression symptoms by year four (Y4) of medical school, and to develop a prognostic index that stratifies risk of developing depression symptoms (Depression-PI) among medical students. Method The authors analyzed data from 3,743 students (79% of 4,732) attending 49 U.S. medical schools who completed baseline (2010) and Y4 (2014) surveys. Surveys included validated scales measuring depression, stress, coping, and social support. The authors collected demographics and school characteristics and conducted multivariate analysis to identify baseline factors independently associated with Y4 depression symptoms. They used these factors to create a prognostic index for developing depression. They randomly divided the data into discovery (n = 2,455) and replication (n = 1,288) datasets and calculated c statistics ( c ). Results The authors identified eight independent prognostic factors for experiencing depression symptoms during training within the discovery dataset: age; race; ethnicity; tuition; and baseline depression symptoms, stress, coping behaviors, and social support. The Depression-PI stratified four risk groups. Compared with the low risk group, those in the intermediate, high, and very high risk groups had an odds ratio of developing depression of, respectively, 1.75, 3.98, and 9.19 ( c = 0.71). The replication dataset confirmed the risk groups. Conclusions Demographics; tuition; and baseline depression symptoms, stress, coping behaviors, and social support are independently associated with risk of developing depression during training among U.S. medical students. By stratifying students into four risk groups, the Depression-PI may allow for a tiered primary prevention approach.

Abstract Healthcare disparities represent differences in the quality of healthcare received by different racial/ethnic or social groups that are the result of inequitable economic, political, social, and psychological processes. This chapter examines enacted stigma (negative feelings, thoughts, and actions) among health care providers and felt stigma among their patients (awareness of the biases and discrimination directed toward them because of their stigmatized condition), each of which can produce disparities in healthcare for stigmatized patients. These processes are considered for individuals from four stigmatized groups: racial minority group members, people who have above average weight or are considered obese, individuals living with HIV, and people with certain cancers. Stronger enacted stigma and felt stigma make communication in interactions with healthcare providers less productive, informative, and positive for members of all four groups. Ultimately, poorer quality communication can contribute to poorer outcomes from these interactions, and thus disparities in health status.