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

Abstract

Congress passed the Health Professions Educational Assistance Act of 1976 to address the crisis in primary care supply in rural and inner-city locations of the United States. This legislation created primary care Health Professional Service Areas (HPSAs), which help states and communities increase their primary care supply through eligibility for loan repayment, technical assistance, increased reimbursement through Medicare, Federally Qualified Health Center (FQHC), and Rural Health Clinic designation. This study examines the degree to which persistence of primary care HPSA designation in rural counties is associated with lower population socioeconomic status and deficiencies in access to health care services.

The Relationships among Self-Designated Disadvantage, Socioeconomic Disadvantage, and Academic Performance in Medical School: A Multi-Institutional Study

“…42,49,50 Medical schools should teach about racism 51 and the impact of curricula and learning environment in reinforcing stereotypes, 52,53 which may influence students' career decisions to practice in high-need communities. 54 Schools should examine the role of examination practices in fostering the social-class achievement gap 55 and potential bias in supervisors' ratings of learners, which may lead to under representation of Black and Asian students in the Alpha Omega Alpha Honor Medical Society and limit their career opportunities. 21,[56][57][58] Teaching institutions should develop policies and trainings to address discrimination 38 and harassment.…”

Examination of Racial Bias in Alpha Omega Alpha Inductions: A Single-Center 15-Year Retrospective Study

“…Here, I provide further evidence there is implicit racial bias against Asian (E/SE) and African-American students in the AOA selection process. I believe the recent Step I paradigm shift will cause such discrepancies to have increasing influence on downstream career paths 26 . Hence, my observations must be investigated thoroughly and addressed honestly by all involved parties.…”

Diversity pipelines: The rationale to recruit and support minority physicians

“…In a recent study, nearly 4000 medical students at 49 schools evaluated their intention to practice in an underserved area and how this intent changed from year 1 to year 4. 26 Students were more likely to express interest in practicing in an underserved area if their medical school made a commitment to diversity, provided a learning orientation toward interracial interactions, required a seminar on minority health, and promoted a larger number of interactions with African American students, faculty, and staff. 26 Other factors associated with either maintaining or increasing intention to practice in an underserved area included perceived skills in developing positive relationships with minority patients and hours of training on racial disparities and bias.…”

“…Structural racism, defined as "the institutions, policies, and norms that are deeply embedded in society and perpetuate racial inequality," is a major barrier to health care equity. 26 Studies show that there exists a similar degree of implicit bias among medical professionals as among the general public and that implicit bias influences clinical judgment. 27 Bias is like a habit:…”