Lasting Effects of Racial Discrimination in Medical School

Racial and ethnic discrimination among medical students was significantly associated with less support for personal and professional development from medical schools, with a disproportionate impact on Black students, according to a study in JAMA Network Open.

In this video interview, author Shruthi Venkataraman, MD, of the New York University Grossman School of Medicine in New York City, discusses the findings and their implications.

The following is a transcript of her remarks:

This study investigates how experience of racial discrimination in medical school impacts students’ perceptions of how well their medical school supports their development as a person and their development as a future physician. The study specifically examines how these experiences and perceptions differ across students from various racial and ethnic groups to highlight any disparities in the way students may experience and be affected by racial discrimination.

And to study these questions, we used national-level data from the Association of American Medical Colleges, the AAMC, for all graduating allopathic medical students in the U.S. for the specific years of our study.

In terms of the results in this study of over 37,000 medical students nationwide, one of the main things we found was that African American or Black students disproportionately experience racial and ethnic discrimination compared to other racial and ethnic groups. It’s actually one in three — around one in three Black students reported experiencing any racial discrimination, and one in five Black students reported experiencing this racial discrimination on a recurrent basis.

To sort of contextualize this, the proportion of Asian and Hispanic students experiencing racial discrimination was around 18% versus 33% among Black students, and only around 4.3% of white students reported experiencing racial discrimination. And we should clarify that in this study we were not able to distinguish students who may identify as being Middle Eastern or North African from the white category. So amongst the low percentage of white students who report experiencing racial discrimination, many might be Middle Eastern or North African. That was one of the main results.

Another important result is that if you look just among students who say that they have never experienced racial discrimination, students of color experienced similar development levels to white students among this group. But when you add racial discrimination to the mix, increased frequency of racial discrimination leads to lower perceived support for development across all racial and ethnic groups.

One thing that’s important to understand in this study is that we are not looking at subtle racial microaggressions that students experience all the time in medicine, that learners experience all the time in medicine.

We assessed racial discrimination through three questions. We asked students, were you denied opportunities for training or rewards based on your race or ethnicity? Were you subjected to racially or ethnically offensive remarks or names? Did you receive lower evaluations or grades due to your race or ethnicity rather than your performance? We are assessing pretty serious instances of racial discrimination that have the potential to really invoke moral injury and really damage your psyche and your ability to function and learn in medical school.

Why is this study important? Well, this study reveals strong, graded, consistent relationships between experiencing racial and ethnic discrimination and a lack of personal and professional development fostered by medical schools among their students. Existing researchers outlined the presence of racial and ethnic discrimination in health professional educational environments, but to our knowledge this is the first study to explore its role in impeding medical student growth.

Another reason this work is important is because it shows that racial discrimination is universally harmful to students from all racial and ethnic backgrounds. So efforts to combat racial discrimination will also benefit all students.

One of the things we want to emphasize is that medical schools should really take a hard look at their learning environments and really listen to what diverse learners are experiencing. Any sort of anti-racism training that’s being offered to students and faculty should continue, especially training that helps people reflect on what their explicit and implicit biases may be and to confront them.

Another thing we recommend is that maybe institutions should regularly audit evaluations and assessments that faculty are giving to students to ensure that there’s equity in assessment.

Also at the level of leadership, there should be robust and anonymous mechanisms that students can use to report when these instances and these experiences of discrimination happen. And there should be clear and transparent pathways that hold the perpetrators accountable.

Another thing leadership can do is increase efforts to recruit and retain a diverse faculty to ensure that the learning environment is reflective of the student population.

Also at the level of accreditation bodies, incorporating personal and professional identity formation as a critical equity metric in accreditation standards may be helpful because this would ensure that medical schools are mandated to ensure equitable development among all students.

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