Erickson Hanna L, Cerjanic Alex M, Adamson Matt, Archey Jo Ann, Jokela Janet A
University of Illinois College of Medicine, Urbana, Illinois, USA.
Teach Learn Med. 2023 Aug-Sep;35(4):389-397. doi: 10.1080/10401334.2022.2082434. Epub 2022 Jun 6.
: Mental shortcuts are commonly used in medical education to facilitate the learning and application of a large volume of information. However, the use of demographic identifiers such as race, ethnicity, region, and descent from one of these groups as mental shortcuts in association with disease can perpetuate misconceptions about the construction of these identities and reinforce stereotypes. The United States Medical Licensing Exam (USMLE) Step 1 is a major driver of pre-clinical undergraduate medical education that requires memorization of a large volume of information and application of this information to clinical vignettes. This study assesses how demographic identifiers have been used in a nearly universally used study resource for this exam. : The authors analyzed a resource that contains "high yield facts" and was built and maintained based on experiences with the USMLE Step 1 for references to race, ethnicity, region, and descent from one of these groups and the distribution of skin tones used in photos. These findings were subsequently compared to the changes made in the 2021 edition of the resource. : The authors found 50 references in the 2020 edition to race, ethnicity, region, and descent from one of these groups, all in relation to disease. More than half of these references had an associated heritable component. Black or African American race was disproportionately represented, comprising more than half of all racial associations (13/24). Additionally, light skin tone was used in 170/204 photos (84.2%) in the 2020 edition. In the 2021 edition, only 12/209 photos (5.7%) were new or changed. : These findings highlight the trend to associate race with disease while also furthering the misconception that there are innate, heritable differences between socially constructed groups and establishing light skin tone as the norm. While some favorable changes were made to the 2021 text, further work within this resource and across medical education is required to avoid further misuse of race and challenge existing implicit biases.
心理捷径在医学教育中普遍被用来促进大量信息的学习和应用。然而，将种族、民族、地区以及来自这些群体之一的血统等人口统计学标识符作为与疾病相关的心理捷径使用，可能会使对这些身份构建的误解长期存在，并强化刻板印象。美国医师执照考试（USMLE）第一步是临床前本科医学教育的主要驱动力，它要求记忆大量信息并将这些信息应用于临床案例。本研究评估了人口统计学标识符在该考试几乎被普遍使用的学习资源中是如何被使用的。：作者分析了一份包含“高收益事实”的资源，该资源基于USMLE第一步的经验构建和维护，以查找其中关于种族、民族、地区以及来自这些群体之一的血统的提及，以及照片中使用的肤色分布情况。随后将这些发现与该资源2021年版所做的更改进行比较。：作者在2020年版中发现了50处关于种族、民族、地区以及来自这些群体之一的血统的提及，均与疾病有关。这些提及中超过一半有相关的遗传成分。黑人或非裔美国人种族的占比过高，占所有种族关联的一半以上（13/24）。此外，2020年版中170/204张照片（84.2%）使用了浅肤色。在2021年版中，只有12/209张照片（5.7%）是新的或有变化的。：这些发现凸显了将种族与疾病联系起来的趋势，同时也进一步加深了这样一种误解，即社会建构的群体之间存在天生的、可遗传的差异，并将浅肤色确立为常态。虽然2021年的文本做了一些有利的更改，但仍需要在该资源内部以及整个医学教育领域开展进一步工作，以避免对种族的进一步误用，并挑战现有的隐性偏见。
