Demographic Differences in Medical Students' Perceptions of Respect for Diversity Among Faculty.

Abstract

Purpose: Faculty role modeling is critical to medical students’ professional development to provide culturally adept, patient-centered care. The behaviors displayed by faculty can directly influence students’ attitudes and behaviors and is considered a part of the “hidden curriculum.” 1 However, little is known about students’ perceptions of faculty role modeling of respect for diversity. The purpose of our study was to examine the perceptions of faculty role modeling of respect for diversity among a nationally representative sample of medical students and to assess the extent to which perceptions varied by student demographics. We hypothesized that students from historically marginalized groups (females; racial/ethnic minorities; and lesbian, gay, or bisexual [LGB]) and older students with greater lived experiences would be more likely to have a negative perception of faculty respect for diversity. Approach/Methods: This cross-sectional study analyzed data from respondents of the 2016 and 2017 Association of American Medical Colleges Graduate Questionnaire (AAMC-GQ). The AAMC-GQ surveyed graduating students at the 140 accredited allopathic U.S. medical schools with graduates as of 2017. Students’ responses from the GQ were linked to self-reported demographic data via AAMC data applications and services, including the American Medical College Application Service, Medical College Admissions Test, and Electronic Residency Application Service. Demographic variables included sex (male vs female), race/ethnicity, sexual orientation (heterosexual, LGB, or unknown), and age. Using multivariable logistic regression, we examined the extent to which student-reported faculty respect for diversity varied by demographic characteristics and sequentially adjusted all logistic regression models first for demographics then for marital status and financial variables. Results: The final study sample consisted of survey responses from 28,778 students, which represented 75.4% of the total 38,160 U.S. medical graduates in 2016 and 2017. Of 28,778 respondents, 48.6% were female, 5.2% identified as LGB. Most identified as White, 20.7% Asian, 5.1% as Black/African American, 8.5% Hispanic/Latinx, and 0.3% American Indian/Alaskan Native/Native Hawaiian or Pacific Islander (AIAN-NHOPI). Over a third (36.8%) of Black/African American students reported a lack of faculty respect for diversity compared with 14.4% of White students—a 3-fold higher odds of perceived lack of respect (OR, 3.24; 95% CI, 2.86–3.66) after adjusting for other demographics and covariates. AIAN-NHOPI (OR, 1.73; 95% CI, 1.03–2.92), Asian (OR, 1.62; 95% CI, 1.49–1.75), and Hispanic/Latinx (OR, 1.43; 95% CI, 1.26–1.75) students also had higher odds compared with White students, as did female compared with male students (OR, 1.17; 95% CI, 1.10–1.25), LGB (OR, 1.96; 95% CI, 1.74–2.22), and “unknown” sexual orientation (OR, 1.79; 95% CI, 1.29–2.47) compared with heterosexual students. Discussion: Over 1 in 6 medical students in our sample reported that faculty lacked respect for diversity. Medical students who identified as racial/ethnic minorities, females, LGB, and older students had higher odds of reporting that faculty lacked respect for diversity when compared with their majority counterparts. This perceived lack of respect for diversity may manifest itself during faculty–patient interactions. Gaps in patient–provider communication perpetuate health disparities and lead to higher levels of bias toward females, LGB, and racial/ethnic minority patients. 2–5 Our study also raises concern that for certain subgroups, a greater prevalence of the perceived lack of faculty respect for diversity may contribute to a more negative institutional psychological climate. Our findings support prior literature that negative faculty behavior contributes to the hidden curriculum. 1 Significance: This study’s findings highlight the need for medical schools, accrediting bodies, and leaders in academia to reaffirm their approach to creating an inclusive environment for all students. Students from marginalized groups disproportionately reported a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of trainees. Acknowledgments: Louisa Holaday, MD, and Joe Ross, MD, MHS (Yale School of Medicine), provided advice and nonfinancial support for this study. No compensation was given for these contributions.