S.M. Phelan is associate professor, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. S.E. Burke is assistant professor, Department of Psychology, Syracuse University, Syracuse, New York. B.A. Cunningham is assistant professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota. S.P. Perry is assistant professor, Departments of Psychology and Medical Social Sciences, Institute for Policy Research, Northwestern University, Evanston, Illinois. R.R. Hardeman is assistant professor, Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota. J.F. Dovidio is professor, Department of Psychology, Yale University, New Haven, Connecticut. J. Herrin is assistant professor, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. L.N. Dyrbye is professor, Department of Medicine, Mayo Clinic, Rochester, Minnesota. R.O. White is assistant professor, Department of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida. M.W. Yeazel is professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota. I.N. Onyeador is postdoctoral fellow, Department of Psychology, Yale University, New Haven, Connecticut. N.M. Wittlin is a PhD candidate, Department of Psychology, Yale University, New Haven, Connecticut. K. Harden is senior program coordinator, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. M. van Ryn is distinguished professor, School of Nursing, Oregon Health & Science University, and founder/president, Institute for Equity & Inclusion Sciences, Portland, Oregon.
Acad Med. 2019 Aug;94(8):1178-1189. doi: 10.1097/ACM.0000000000002719.
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.
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.
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.
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.
本研究旨在探讨医学院中种族主义表现与医学生毕业后在服务不足或少数族裔社区执业的意愿变化之间的关系，与入学时的态度和意愿相比。
作者使用了来自美国 49 所医学院的 3756 名学生的纵向研究的重复测量数据，这些数据是在 2010 年至 2014 年期间收集的。他们进行了广义线性混合模型分析，以评估学校课程/政策、学校文化/氛围或学生态度/行为中的种族主义表现是否预测了学生在服务不足社区或主要为少数族裔人群执业的意愿从一年级到四年级的变化。分析按学生入学时的执业意图（无/未决定/是）进行分层。
学生更消极的明确种族态度与毕业时从事服务不足或少数族裔人群执业的意愿下降有关。服务学习经验和以改善少数族裔健康为重点的课程与在服务不足的社区执业的意愿增加有关。以少数族裔健康/差异为重点的课程、学生与少数族裔患者建立关系的技能感知、学校的少数族裔学生比例以及跨种族环境紧张的感知都与照顾少数族裔患者的意愿增加有关。
本研究提供的证据表明，医学院中表现出的多种层面的种族主义与即将毕业的学生在高需求社区提供护理的决定有关。需要制定策略来识别和消除医学院中结构性种族主义及其表现。
