Assessing the Impact of Race, Sexual Orientation, and Gender Identity on USMLE Style Questions: Preliminary Results of a Randomized Controlled Trial

Abstract

Abstract Introduction/Objective Medical students are expected to graduate with cultural competence, which improves the quality of care of different minority groups and may help reduce health disparities. Incorporation of diversity, equity, and inclusion into medical teaching is critical to the development of culturally competent physicians; however, centuries of medical pedagogy have tied certain pathologies to racial and sexual/gender minority patients. This not only encourages stereotyping to arrive at the correct answer but also narrows the differential diagnosis developed by the future physician. We are surveying US and non-US third- and fourth-year medical students and first-year residents to demonstrate to what extent inclusion of race, sexual orientation, and gender identity data in question stems influences diagnosis and clinical decision-making. Methods/Case Report The survey consists of three sections. The first section collects demographic information, including age, race, gender identity, region, type of medical degree, current level of training, completion of examinations, and MCAT score. The second section presents one of two sets of twelve USMLE style questions with (experimental) or without (control) key demographic data, including race, sexual orientation, and gender identity. The third section presents four questions in order to assess participants’ understanding of the higher burden of hypertension among Black patients and attitudes regarding the role of their medical education in the development of biases. Participants were randomized to the set of twelve questions in the second section. Results (if a Case Study enter NA) Preliminary results from 25 medical trainees associated with Loyola University Chicago demonstrate that the presence of demographic data including race, sexual orientation, and gender identity impact answer choice on standardized questions. Conclusion The preliminary results of this study are significant because they suggest that race, sexual orientation, and gender identity are still being used in pathology education to highlight certain disease processes, potentially in a manner that is out of proportion to actual disease prevalence.