Sheth Neeral K, Wilson Adam B, West James C, Schilling David C, Rhee Sandy H, Napier T Celeste
Rush University Medical Center, Chicago, IL, USA.
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Acad Psychiatry. 2025 Apr;49(2):126-135. doi: 10.1007/s40596-024-02103-5. Epub 2024 Dec 20.
Substance use disorder (SUD) continues to be one of the most stigmatized and under-treated conditions in the United States. Stigmatizing language used by healthcare workers can transmit bias to others within healthcare, including medical trainees. This study investigates how stigmatizing language and undergraduate medical education (UME) curricula may influence trainees' clinical decision-making for patients with SUD.
Medical students from three Chicago-area medical schools were randomized to review either a stigmatizing or neutral version of a clinical scenario describing a patient experiencing opioid withdrawal. Participants (a) selected treatment plans for the fictional patient using two multiple-choice questions, (b) completed the Medical Condition Regard Scale (MCRS) to assess their attitudes, and (c) reported prior SUD experiences, both curricular and personal. Statistical analyses explored whether treatment decisions were influenced by attitudes, addiction medicine curricula, and exposure to the stigmatizing vignette.
Among the 366 medical students who completed this study, exposure to stigmatizing language (n = 191) led to clinical decision-making that would be less effective in treating opioid withdrawal for the fictional patient (p = 0.027; η2 = 0.013). Exposure to more SUD education during UME was correlated with more effective clinical decision-making for opioid withdrawal (β = 0.181; R = 0.033; p < 0.001) but was not correlated with attitudes toward patients with SUD (p = 0.231).
Stigmatizing language influences clinical decision-making when treating patients with SUD. Improving SUD education within UME may be an effective strategy for mitigating this effect within medical trainees.
物质使用障碍（SUD）在美国仍然是最受污名化且治疗不足的病症之一。医护人员使用的污名化语言会将偏见传递给医疗保健领域的其他人，包括医学实习生。本研究调查污名化语言和本科医学教育（UME）课程如何影响实习生对患有SUD患者的临床决策。
来自芝加哥地区三所医学院的医学生被随机分组，分别阅读描述阿片类药物戒断患者的带有污名化或中性色彩的临床病例。参与者（a）通过两个多项选择题为虚构患者选择治疗方案，（b）完成医疗状况关注量表（MCRS）以评估他们的态度，（c）报告先前在课程和个人方面的SUD经历。统计分析探讨治疗决策是否受到态度、成瘾医学课程以及接触污名化病例的影响。
在完成本研究的366名医学生中，接触污名化语言（n = 191）导致临床决策对虚构患者阿片类药物戒断的治疗效果较差（p = 0.027；η2 = 0.013）。在UME期间接受更多SUD教育与对阿片类药物戒断更有效的临床决策相关（β = 0.181；R = 0.033；p < 0.001），但与对患有SUD患者的态度无关（p = 0.231）。
污名化语言在治疗患有SUD的患者时会影响临床决策。改善UME中的SUD教育可能是减轻医学实习生这种影响的有效策略。
