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J Gen Intern Med. 2017 Aug 1. doi: 10.1007/s11606-017-4127-6. [Epub ahead of print]

Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students.

Author information

1
Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA. Phelan.sean@mayo.edu.
2
Department of Psychology, Yale University, New Haven, CT, USA.
3
Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
4
Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
5
Department of Psychology, Northwestern University, Evanston, IL, USA.
6
Division of Infectious Diseases, Department of Medicine, Georgetown University Medical School, Washington, DC, USA.
7
Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
8
Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA.

Abstract

BACKGROUND:

Implicit and explicit bias among providers can influence the quality of healthcare. Efforts to address sexual orientation bias in new physicians are hampered by a lack of knowledge of school factors that influence bias among students.

OBJECTIVE:

To determine whether medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias among graduating students against gay and lesbian people.

DESIGN:

Prospective cohort study.

PARTICIPANTS:

A sample of 4732 first-year medical students was recruited from a stratified random sample of 49 US medical schools in the fall of 2010 (81% response; 55% of eligible), of which 94.5% (4473) identified as heterosexual. Seventy-eight percent of baseline respondents (3492) completed a follow-up survey in their final semester (spring 2014).

MAIN MEASURES:

Medical school predictors included formal curriculum, role modeling, diversity climate, and contact with sexual minorities. Outcomes were year 4 implicit and explicit bias against gay men and lesbian women, adjusted for bias at year 1.

KEY RESULTS:

In multivariate models, lower explicit bias against gay men and lesbian women was associated with more favorable contact with LGBT faculty, residents, students, and patients, and perceived skill and preparedness for providing care to LGBT patients. Greater explicit bias against lesbian women was associated with discrimination reported by sexual minority students (b = 1.43 [0.16, 2.71]; p = 0.03). Lower implicit sexual orientation bias was associated with more frequent contact with LGBT faculty, residents, students, and patients (b = -0.04 [-0.07, -0.01); p = 0.008). Greater implicit bias was associated with more faculty role modeling of discriminatory behavior (b = 0.34 [0.11, 0.57); p = 0.004).

CONCLUSIONS:

Medical schools may reduce bias against sexual minority patients by reducing negative role modeling, improving the diversity climate, and improving student preparedness to care for this population.

KEYWORDS:

longitudinal studies; medical education; prejudice; sexual minorities; sexual orientation

PMID:
28766125
DOI:
10.1007/s11606-017-4127-6
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