Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Neurology, The University of Michigan Medical School, Ann Arbor, Michigan, USA.
Med Educ. 2023 Jun;57(6):523-534. doi: 10.1111/medu.14995. Epub 2022 Dec 14.
The objective of this study is to investigate whether self-disclosed disability and self-reported program access are associated with measures of empathy and burnout in a national sample of US medical students.
The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability-related questions, including self-reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal-related and learning environment measures.
Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self-reported a disability. Most medical students with disabilities (SWD) self-reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34-1.69] and 2.59 [95% CI, 1.93-3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67-.85] and 0.68 [95% CI, 0.52-0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09-1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97-1.22]).
Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians.
本研究旨在调查美国医学生的全国样本中，自我披露的残疾状况和自我报告的项目获取情况是否与同理心和倦怠感的测量指标相关。
作者从 2019 年和 2020 年回应医学学院协会（AAMC）第 2 年问卷（Y2Q）的学生那里获得了数据。数据包括人口统计学特征、个人变量、学习环境指标、倦怠感（医学生奥伦伯格倦怠量表）、同理心（人际反应指数）和与残疾相关的问题，包括自我报告的残疾、残疾类别和项目获取。使用多变量逻辑回归模型，根据 YQ2 人口统计学、个人相关和学习环境措施，评估残疾状况、项目获取、同理心和倦怠感之间的关联。
总体而言，23898 人（54.2%）提供了残疾数据并被纳入研究。其中，2438 人（10.2%）自我报告有残疾。大多数有残疾的医学生（SWD）自我报告通过适应性措施（1215 人[49.8%]）或无障碍获取（824 人[33.8%]）获得项目。多变量模型表明，与无残疾的学生相比，有和没有项目获取的 SWD 表现出更高的高度疲惫感的可能性（1.50 [95%CI，1.34-1.69] 和 2.59 [95%CI，1.93-3.49]），以及更低的同理心可能性（0.75 [95%CI，0.67-0.85] 和 0.68 [95%CI，0.52-0.90]）。相比之下，脱离参与的多变量模型表明，与无残疾的学生相比，报告缺乏项目获取的 SWD 更有可能出现高度脱离参与（1.43 [95%CI，1.09-1.87]），而有项目获取的 SWD 则没有（1.09 [95%CI，0.97-1.22]）。
尽管疲惫感较高的可能性更大，但无论项目获取情况如何，SWD 更不可能表现出同理心较低，而有项目获取的 SWD 在脱离参与方面与无残疾的学生没有差异。这些发现增加了我们对 SWD 的特征和经历的理解，包括他们作为有同理心的未来医生的贡献。
