Medical Decision Making Among Medical Students

There have been a number of studies that have shown that racial and ethnic minorities do not receive therapeutic medical procedures at the same rates as non-Hispanic whites. The strongest evidence of these racial disparities is in the utilization of invasive cardiac procedures such as recommending medication verses surgery. The cause of these racial disparities remains unclear, but geographic and financial access, underlying morbidity, insurance status, and income cannot fully explain the differences. There is suggestive evidence that a contributing factor is a difference in the rate at which physicians offer these procedures to patients based on race and/or gender, and that such biases may be present in medical students. The central focus of this research is on the medical school’s role in forming, reinforcing or diminishing subtle stereotypes medical students may have that lead to these health disparities.

1. Quantify the extent of racial and gender based medical decision-making biases among the nation’s senior medical students,
2. Describe the context in which medical student medical decision-making processes are formed, comparing schools whose students vary in the extent of decision-making biases demonstrated, and
3. Develop recommendations for admissions &/or training processes to reduce the prevalence of decision-making biases.

1. A national survey will be conducted of all senior medical students at 133 medical schools. The survey will consist of a set of clinical vignettes that will explore the effect of patient race, gender and socioeconomic status on the students’ cardiac procedural recommendations, preventative care, and non-cardiac clinical scenarios.
2. Case studies will be conducted at 14 medical schools selected on the basis on the students’ responses to the survey. The primary data will include both in-depth face-to-face interviews and follow-up telephone interviews with senior medical students and selected faculty together with compilation of existing documents, such as curricula, policies, and course descriptions.
3. A set of recommendations for medical educators will be developed to guide cultural competency training and steps to reduce the prevalence of racial and gender bias in medical decision-making.

Funding

This study is funded by the National Institutes of Health Minority Health and Health Disparities Research.

Contact

For more information contact Dr. Robert Williams, M.D. at 505-272-2165, rlwilliams@salud.unm.edu; or Crystal Romney at 505-272-1571, cromney@salud.unm.edu