E.R. Colson is professor of pediatrics and associate dean for program evaluation and continuous quality improvement, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
M. Pérez is clinical research specialist, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S131-S135. doi: 10.1097/ACM.0000000000003702.
In 2018, in response to a news story featuring the Icahn School of Medicine's decision to eliminate its chapter of Alpha Omega Alpha (AOA) due to perceived racial inequities, students at Washington University School of Medicine in St. Louis (WUSM) brought similar concerns to leadership. WUSM leadership evaluated whether students' race, ethnicity, and gender were associated with their receipt of honors in the 6 core clerkships, key determinants of AOA selection. In preliminary analysis of the school's data, statistically significant racial and ethnic disparities were associated with receipt of honors in each clerkship. Leaders shared these findings with the WUSM community along with a clear message that such discrepancies are unacceptable to the school. An effort to further analyze what lay behind the findings as well as to identify steps to resolve the problem was launched. Using a quality improvement framework, data from focus groups and student surveys were analyzed and 2 overarching themes emerged. Students perceived that both assessment and the learning environment impacted racial/ethnic disparities in clerkship grades. In multivariable logistic regression models, shelf exam scores (a part of student assessment) were found to be associated with receipt of honors in each clerkship; in some (but not all) clerkships, shelf exam scores attenuated the effect of race/ethnicity on receipt of honors, so that when the shelf scores were added to the model, the race/ethnicity effect was no longer significant. This case study describes WUSM's process to understand and address bias in clerkship grading and AOA nomination so that other medical schools might benefit from what has been learned.
2018 年，针对一篇新闻报道，该报道称由于认为存在种族不平等现象，伊坎医学院决定取消其阿尔法欧米茄阿尔法分会（AOA），圣路易斯华盛顿大学医学院（WUSM）的学生向领导层提出了类似的担忧。WUSM 领导层评估了学生的种族、族裔和性别是否与他们在 6 项核心实习课程中的荣誉获得有关，这是 AOA 选拔的关键决定因素。在对学校数据的初步分析中，每个实习课程的荣誉获得与明显的种族和族裔差异相关。领导层与 WUSM 社区分享了这些发现，并明确表示学校不能接受这种差异。学校发起了一项努力，进一步分析这些发现背后的原因，并确定解决问题的步骤。使用质量改进框架，对焦点小组和学生调查的数据进行了分析，出现了两个总体主题。学生们认为评估和学习环境都对实习成绩的种族/族裔差异产生了影响。在多变量逻辑回归模型中，架子考试成绩（学生评估的一部分）与每个实习课程的荣誉获得相关；在一些（但不是全部）实习课程中，架子考试成绩减弱了种族/族裔对荣誉获得的影响，因此，当架子分数被添加到模型中时，种族/族裔的影响不再显著。本案例研究描述了 WUSM 理解和解决实习成绩和 AOA 提名中的偏见的过程，以便其他医学院可以从中受益。
