Available online 11 November 2022

Introduction

It is well documented that medical students who identify as underrepresented in medicine are more likely to encounter social challenges in the clinical environment. Successful navigation of these challenges requires a social and emotional agility that is unmeasured in traditional metrics of success. The effects of this requirement has not yet been explored. The authors therefore set out to investigate the variations in experiences that exist between underrepresented minority students in medicine (URiM) and white students, and to determine if there was a difference in the quantitative performance evaluations applied to both groups of students.

Methods

This was a mixed-methods study. In the quantitative portion, the authors retrospectively analyzed the standardized patient encounter scores of medical students from a single medical school in Michigan during the years of 2016 to 2018. The authors used multivariable ordinary least squares regression models to evaluate the differences in scores by race. In the qualitative portion, students volunteered to be interviewed and self-identified their race and gender. The authors employed semi-structured interview techniques to gather information about how the student felt their cultural or ethnic background affected their experience in the clinical environment.

Results

For the quantitative portion of this study, the authors analyzed the scores of 534 students over 4 different standardized patient encounters. The average score across all 4 standardized patient encounters was 88.7 (SD=5.6). The average score across all 4 standardized patient encounters for white students was 89 (SD=5.3), Black 87.9 (SD=7.4) Twenty-four students participated in the semi-structured interviews. Participants described feeling that the way their assessors interacted with them was largely affected by their race or gender. They also described feeling tension between how they would usually express themselves and how they were expected to in the clinical environment. When probed further, participants described various methods of adaptation to this tension including changing their hair or natural style of speech and modifying their perception of their role in the clinical environment.

Section snippetsQuantitative Study Design

Standardized patient encounter grading data from the University of Michigan Medical School students matriculating 2016 to 2018 was analyzed. Outcomes of interest included scores for communication on 4 unique standardized patient exercises. The standardized patient exercises over the selected years were identical. These exercises were designed by the longitudinal clinical history and physical exam building course. Students were assessed for their ability to perform an appropriate history and

Quantitative

The communication scores of 534 students for 4 unique standardized patient exercises were analyzed (Table 1). Three-hundred and 10 (59%) students self-identified as men, and 219(41%) students self-identified as women. Three-hundred and seventeen (59.4%) students self-identified as non-Hispanic white, 37(6.9%) as non-Hispanic Black, 45(8.4%) as Hispanic, 104(19.5%) as Asian, and 31 (5.8%) either identified as other or did not report. Four standardized patient exercises were evaluated. The

DISCUSSION

Over the last decade, more emphasis has been placed on the health disparities experienced by marginalized groups in society. In response, medical schools have placed more value on class compositions that are as ethnically and racially diverse as our country, not only because of the intrinsic value of diversity but also because it is known that racialized minorities are more likely to provide care to populations that experience health disparities.16 But while diversity gains have been achieved

FUNDING/SUPPORT

None

OTHER DISCLOSURES

None

ETHICAL APPROVAL

This study was deemed exempt by the University of Michigan Institutional Review Board (HUM00180709)

DISCLAIMERS

None

PREVIOUS PRESENTATIONS

The quantitative portions of this study were shared in a poster presentation at the Association for Surgical Education Annual Meeting in May 2022

ACKNOWLEDGMENTS

We are grateful to the participants of this study for their trust and vulnerability. We extend a special thanks to Laura Gerhardinger for her assistance with data analysis.

References (25)JF Garrick et al.The diversity snowball effect: The quest to increase diversity in emergency medicine: A case study of highland's emergency medicine residency program

Ann Emerg Med

(2019)

CM Maxfield et al.You're Biased! Deal With It

J Am Coll Radiol

(2021)

KL Odom et al.Exploring obstacles to and opportunities for professional success among ethnic minority medical students

Acad Med

(2007)

H Orom et al.The social and learning environments experienced by underrepresented minority medical students: a narrative review

Acad Med

(2013)

JM Liebschutz et al.In the minority: Black physicians in residency and their experiences

J Natl Med Assoc

(2006)

DC Baldwin et al.Student perceptions of mistreatment and harassment during medical school. A survey of ten United States schools

West J Med

(1991)

D Babbott et al.Primary care by desire or default? Specialty choices of minority graduates of US medical schools in 1983

J Natl Med Assoc

(1994)

B. BeaganMicro inequities and everyday inequalities: “race,” gender, sexuality and class in medical school

The Canadian Journal of Sociology /Cahiers canadiens de sociologie

(2001)

JQ Young et al.Cognitive load theory: Implications for medical education: AMEE Guide No. 86

Medical Teacher

(2014)

P Chandler et al.Cognitive load theory and the format of instruction

Cognition and Instruction

(1991)

J Reteguiz et al.Clerkship timing and disparity in performance of racial-ethnic minorities in the medicine clerkship

J Natl Med Assoc

(2002)

IC McManus et al.Final examination performance of medical students from ethnic minorities

Med Educ

(1996)

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