Abstract
BackgroundMedical training focuses heavily on clinical skills but lacks in training for navigating challenging clinical scenarios especially with regard to diversity issues. Our objective was to assess third-year medical students’ preparedness to navigate such scenarios.MethodsA 24-item survey was administered electronically to third-year medical students describing a range of specific interactions with patients, peers, and “upper-levels” or superiors including residents and attendings, spanning subjects including gender, race/ethnicity, politics, age, sexual orientation/identity, disability, and religion. Students rated their level of comfort via a 5-point Likert scale ranging from 1 (“Very Uncomfortable”) to 5 (“Very Comfortable”). Basic demographics were collected and data were summarized for trends.ResultsData were analyzed from 120 students (67% response rate, 54.2% female, 60.8% non-Hispanic white). Students reported lower comfort with peer and superiors compared to patient interactions (p < 0.0001). Students reported the highest comfort with sexual orientation/identity- and religion-related interactions (median (IQR): 3.3 (1.3) and 3.4 (10.0), respectively) and the lowest comfort with gender-, race/ethnicity-, and disability- related interactions (median (IQR): 2.3 (1.3), 2.0 (1.0), 2.5 (1.5), respectively). Males reported significantly higher median comfort levels for scenarios with upper-level, gender, and religion related interactions. Males were more likely to be completely comfortable versus females across the 24 scenarios, although multiple male response patterns showed evidence of a bimodal distribution.ConclusionsThird-year medical students report generally inadequate comfort with navigating complex clinical scenarios, particularly with peers and supervisors and relating to gender-, race/ethnicity-, and disability-specific conflicts. There are differences across gender with regards to median comfort and distribution of scores suggesting that there is a subgroup of males report high/very high comfort with challenging clinical scenarios. Students may benefit from enhanced training modules and personalized toolkits for navigating these scenarios.
Highlights
Medical training focuses heavily on clinical skills but lacks in training for navigating challenging clinical scenarios especially with regard to diversity issues
The sample was 54.2% female and 60.8% non-Hispanic white (see Table, Additional File 2, which illustrates the characteristics of third-year medical students who completed the Navigating Challenging Clinical Scenarios survey (n = 120)
Students reported the highest comfort with sexual orientation/identity- and religion-related interactions (median (IQR): 3.3 (1.3) and 3.4 (10.0), respectively) and the lowest comfort with gender, race/ethnicity, and disability- related interactions (median (IQR): 2.3 (1.3), 2.0 (1.0), 2.5 (1.5), respectively)
Summary
Medical training focuses heavily on clinical skills but lacks in training for navigating challenging clinical scenarios especially with regard to diversity issues. Medical school training is heavily focused on building clinical skills, but often lacking training in navigating challenging clinical scenarios, those involving diversity-related issues. Contemporary curricula often include robust training on empathy, compassion and useful skills to address disparities and inequities in health care; missing may be the cultivation of conflict management skills. To this end, it has been suggested that medical students would universally benefit from a curriculum that emphasizes clinical skill building, and conflict management and self-reflection around diversity-related topics [1]. Data representing interactions with patients, peers, and superiors with a broad range of diversity-related issues may inform the development of further teaching modules or case-based education to better prepare medical students to navigate these challenging clinical scenarios
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