Selden Elizabeth, Perry Julia, Cockett-Nagamine Kahiau, Agarwal Ritu, Bacon Austin
is an Associate Professor of Medicine, Medstar Georgetown University Hospital, Washington, DC, USA.
is a Third-Year Medical Student, Georgetown University School of Medicine, Washington, DC, USA.
J Grad Med Educ. 2025 Aug;17(4):479-485. doi: 10.4300/JGME-D-24-00981.1. Epub 2025 Aug 15.
Race has long been treated as a biological determinant in medicine, and many US faculty still reference it in clinical contexts. As the field shifts away from this model, the medical community faces the challenge of addressing how race shapes patients' experiences and outcomes without reinforcing harmful practices. Internal medicine residents must navigate this transition amid conflicting guidance on incorporating race into clinical reasoning. Understanding how residents currently conceptualize and apply race in clinical contexts is essential to preparing them to deliver equitable, patient-centered care. To understand residents' beliefs regarding race in clinical decision-making. We conducted a qualitative study using semistructured interviews with residents from 3 US internal medicine residency programs within a single institution between February and April 2023. Participants were recruited via email, presented with a clinical vignette, and asked about clinical management and the impact of race on their decisions. We conducted an inductive thematic analysis to identify emergent themes and interpreted the findings through Jean Piaget's framework of cognitive conflict and learning. Twenty-four residents completed the study. Three main themes emerged: (1) a persistent belief in race-based medicine where beliefs and clinical reasoning aligned around the idea of race as biological; (2) a disequilibrium defined by discrepancy between beliefs and clinical reasoning; and (3) a new equilibrium marked by alignment around race as a social construct and recognition of racism's impact on individual health. Residents described dissonance between understanding race as a social construct and encountering clinical norms treating it as biological, revealing a process of questioning and reframing how race is used in clinical care.
长期以来，种族在医学上一直被视为一种生物学决定因素，许多美国教员在临床环境中仍会提及它。随着该领域逐渐摒弃这种模式，医学界面临着一个挑战，即如何在不强化有害做法的情况下，探讨种族如何塑造患者的就医体验和治疗结果。内科住院医师必须在关于将种族纳入临床推理的相互矛盾的指导意见中应对这一转变。了解住院医师目前如何在临床环境中概念化和应用种族，对于使他们能够提供公平的、以患者为中心的医疗服务至关重要。为了了解住院医师在临床决策中对种族的看法，我们于2023年2月至4月期间，对同一机构内3个美国内科住院医师培训项目的住院医师进行了半结构化访谈，开展了一项定性研究。通过电子邮件招募参与者，向他们展示一个临床案例，并询问他们的临床管理情况以及种族对其决策的影响。我们进行了归纳主题分析，以确定新出现的主题，并通过让·皮亚杰的认知冲突和学习框架来解释研究结果。24名住院医师完成了这项研究。出现了三个主要主题：（1）对基于种族的医学的持续信念，即信念和临床推理围绕着种族是生物学概念这一观点保持一致；（2）由信念与临床推理之间的差异所定义的失衡状态；（3）以围绕种族作为一种社会建构达成一致以及认识到种族主义对个人健康的影响为标志的新的平衡状态。住院医师们描述了将种族理解为一种社会建构与遇到将其视为生物学概念的临床规范之间的不一致，揭示了一个对临床护理中如何使用种族进行质疑和重新构建的过程。
