The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities

Sean M. Phelan, Sara Emily Burke, Brooke A. Cunningham, Sylvia P. Perry, Rachel R. Hardeman, John F. Dovidio, Jeph Herrin, Liselotte N. Dyrbye, Richard O. White, Mark W. Yeazel, Ivuoma N. Onyeador, Natalie M. Wittlin, Kristin Harden, Michelle van Ryn

Research output: Contribution to journalArticle

Abstract

PURPOSE: The purpose of this study was to examine the relationship between manifestations of racism in medical school and subsequent changes in graduating medical students' intentions to practice in underserved or minority communities, compared with their attitudes and intentions at matriculation. METHOD: The authors used repeated-measures data from a longitudinal study of 3,756 students at 49 U.S. medical schools that were collected from 2010 to 2014. They conducted generalized linear mixed models to estimate whether manifestations of racism in school curricula/policies, school culture/climate, or student attitudes/behaviors predicted first- to fourth-year changes in students' intentions to practice in underserved communities or primarily with minority populations. Analyses were stratified by students' practice intentions (no/undecided/yes) at matriculation. RESULTS: Students' more negative explicit racial attitudes were associated with decreased intention to practice with underserved or minority populations at graduation. Service learning experiences and a curriculum focused on improving minority health were associated with increased intention to practice in underserved communities. A curriculum focused on minority health/disparities, students' perceived skill at developing relationships with minority patients, the proportion of minority students at the school, and the perception of a tense interracial environment were all associated with increased intention to care for minority patients. CONCLUSIONS: This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students' decisions to provide care in high-need communities. Strategies to identify and eliminate structural racism and its manifestations in medical school are needed.

Original languageEnglish (US)
Pages (from-to)1178-1189
Number of pages12
JournalAcademic medicine : journal of the Association of American Medical Colleges
Volume94
Issue number8
DOIs
StatePublished - Aug 1 2019

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racism
minority
community
education
student
school
curriculum
school culture
health
medical student
longitudinal study
climate
learning
evidence
experience

ASJC Scopus subject areas

  • Education

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The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities. / Phelan, Sean M.; Burke, Sara Emily; Cunningham, Brooke A.; Perry, Sylvia P.; Hardeman, Rachel R.; Dovidio, John F.; Herrin, Jeph; Dyrbye, Liselotte N.; White, Richard O.; Yeazel, Mark W.; Onyeador, Ivuoma N.; Wittlin, Natalie M.; Harden, Kristin; van Ryn, Michelle.

In: Academic medicine : journal of the Association of American Medical Colleges, Vol. 94, No. 8, 01.08.2019, p. 1178-1189.

Research output: Contribution to journalArticle

Phelan, SM, Burke, SE, Cunningham, BA, Perry, SP, Hardeman, RR, Dovidio, JF, Herrin, J, Dyrbye, LN, White, RO, Yeazel, MW, Onyeador, IN, Wittlin, NM, Harden, K & van Ryn, M 2019, 'The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities', Academic medicine : journal of the Association of American Medical Colleges, vol. 94, no. 8, pp. 1178-1189. https://doi.org/10.1097/ACM.0000000000002719
Phelan, Sean M. ; Burke, Sara Emily ; Cunningham, Brooke A. ; Perry, Sylvia P. ; Hardeman, Rachel R. ; Dovidio, John F. ; Herrin, Jeph ; Dyrbye, Liselotte N. ; White, Richard O. ; Yeazel, Mark W. ; Onyeador, Ivuoma N. ; Wittlin, Natalie M. ; Harden, Kristin ; van Ryn, Michelle. / The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities. In: Academic medicine : journal of the Association of American Medical Colleges. 2019 ; Vol. 94, No. 8. pp. 1178-1189.
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