Department of Nutrition, University of North Carolina School of Medicine, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
BMC Med Educ. 2020 Mar 12;20(1):71. doi: 10.1186/s12909-020-1984-1.
Medical training focuses heavily on clinical skills but lacks in training for navigating challenging clinical scenarios especially with regard to diversity issues. Our objective was to assess third-year medical students' preparedness to navigate such scenarios.
A 24-item survey was administered electronically to third-year medical students describing a range of specific interactions with patients, peers, and "upper-levels" or superiors including residents and attendings, spanning subjects including gender, race/ethnicity, politics, age, sexual orientation/identity, disability, and religion. Students rated their level of comfort via a 5-point Likert scale ranging from 1 ("Very Uncomfortable") to 5 ("Very Comfortable"). Basic demographics were collected and data were summarized for trends.
Data were analyzed from 120 students (67% response rate, 54.2% female, 60.8% non-Hispanic white). Students reported lower comfort with peer and superiors compared to patient interactions (p < 0.0001). Students reported the highest comfort with sexual orientation/identity- and religion-related interactions (median (IQR): 3.3 (1.3) and 3.4 (10.0), respectively) and the lowest comfort with gender-, race/ethnicity-, and disability- related interactions (median (IQR): 2.3 (1.3), 2.0 (1.0), 2.5 (1.5), respectively). Males reported significantly higher median comfort levels for scenarios with upper-level, gender, and religion related interactions. Males were more likely to be completely comfortable versus females across the 24 scenarios, although multiple male response patterns showed evidence of a bimodal distribution.
Third-year medical students report generally inadequate comfort with navigating complex clinical scenarios, particularly with peers and supervisors and relating to gender-, race/ethnicity-, and disability-specific conflicts. There are differences across gender with regards to median comfort and distribution of scores suggesting that there is a subgroup of males report high/very high comfort with challenging clinical scenarios. Students may benefit from enhanced training modules and personalized toolkits for navigating these scenarios.
医学培训侧重于临床技能，但缺乏应对具有挑战性的临床场景的培训，尤其是涉及多样性问题的场景。我们的目标是评估三年级医学生应对此类场景的准备情况。
通过电子方式向三年级医学生发放了一份 24 项的调查问卷，描述了与患者、同行以及包括住院医生和主治医生在内的“上级”或上级之间的一系列具体互动，涵盖了性别、种族/民族、政治、年龄、性取向/身份、残疾和宗教等主题。学生通过 5 点 Likert 量表对自己的舒适度进行评分，范围从 1（“非常不舒服”）到 5（“非常舒适”）。收集了基本人口统计学数据，并对数据进行了总结以分析趋势。
共分析了 120 名学生的数据（回复率为 67%，女性占 54.2%，非西班牙裔白人占 60.8%）。与患者互动相比，学生报告与同行和上级互动时的舒适度较低（p<0.0001）。学生报告在性取向/身份和宗教相关互动方面的舒适度最高（中位数（IQR）：3.3（1.3）和 3.4（10.0）），而在性别、种族/民族和残疾相关互动方面的舒适度最低（中位数（IQR）：2.3（1.3）、2.0（1.0）、2.5（1.5））。男性报告在与上级、性别和宗教相关的互动场景中舒适度显著更高。与女性相比，男性在 24 个场景中更有可能完全感到舒适，尽管多个男性的反应模式表明存在双峰分布。
三年级医学生普遍报告在应对复杂临床场景方面的舒适度不足，尤其是在与同行和主管以及与性别、种族/民族和残疾相关的冲突方面。在舒适度中位数和分数分布方面存在性别差异，这表明有一小部分男性报告在具有挑战性的临床场景中高度/非常舒适。学生可能受益于增强的培训模块和个性化工具包，以应对这些场景。
