Ewen S C, Barrett J, Paul D, Askew D, Webb G, Wilkin A
Melbourne Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Aboriginal Health, School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
Intern Med J. 2015 Aug;45(8):805-12. doi: 10.1111/imj.12800.
Disparity in health status and healthcare outcomes is widespread and well known. This holds true for Indigenous peoples in many settings including Australia and Hawaii. While multi-factorial, there is increasing evidence of health practitioner contribution to this disparity. This research explored senior medical students' clinical decision-making processes.
A qualitative study was conducted in 2014 with 30 final year medical students from The University of Melbourne, Australia, and The John Burns Medical School, Hawaii, USA. Each student responded to questions about a paper-based case, first in writing and elaborated further in an interview. Half the students were given a case of a patient whose ethnicity was not declared; the other half considered the patient who was Native Hawaiian or Australian Aboriginal. A systematic thematic analysis of the interview transcripts was conducted.
The study detected subtle biases in students' ways of talking about the Indigenous person and their anticipation of interacting with her as a patient. Four main themes emerged from the interview transcripts: the patient as a person; constructions of the person as patient; patient-student/doctor interactions; and the value of various education settings. There was a strong commitment to the patient's agenda and to the element of trust in the doctor-patient interaction.
These findings will help to advance medical curricula so that institutions graduate physicians who are increasingly able to contribute to equitable outcomes for all patients in their care. The study also draws attention to subtle biases based on ethnicity that may be currently at play in physicians' practices.
健康状况和医疗结果的差异普遍存在且广为人知。在包括澳大利亚和夏威夷在内的许多地区，原住民的情况皆是如此。尽管存在多方面因素，但越来越多的证据表明医疗从业者对这种差异也有影响。本研究探讨了高年级医学生的临床决策过程。
2014年对来自澳大利亚墨尔本大学和美国夏威夷约翰·伯恩斯医学院的30名医学专业最后一年的学生进行了一项定性研究。每位学生针对一个纸质病例回答问题，先书面作答，然后在访谈中进一步阐述。一半学生拿到的病例中患者的种族未标明；另一半学生考虑的患者是夏威夷原住民或澳大利亚原住民。对访谈记录进行了系统的主题分析。
该研究在学生谈论原住民患者以及预期与患者互动的方式中发现了微妙的偏见。访谈记录中出现了四个主要主题：患者作为个体；将个体建构为患者；患者与学生/医生的互动；以及各种教育环境的价值。学生们坚决支持患者的议程以及医患互动中的信任要素。
这些发现将有助于推进医学课程，以便各院校培养出越来越有能力为其护理的所有患者实现公平结果做出贡献的医生。该研究还提请人们注意目前医生在诊疗过程中可能存在的基于种族的微妙偏见。
